Provider Demographics
NPI:1497094908
Name:ERIC M KNAFF P.A.
Entity Type:Organization
Organization Name:ERIC M KNAFF P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:M
Authorized Official - Last Name:KNAFF
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:651-464-3425
Mailing Address - Street 1:69 LAKE ST N STE 100
Mailing Address - Street 2:
Mailing Address - City:FOREST LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55025-2527
Mailing Address - Country:US
Mailing Address - Phone:651-464-3425
Mailing Address - Fax:651-464-5432
Practice Address - Street 1:69 LAKE ST N STE 100
Practice Address - Street 2:
Practice Address - City:FOREST LAKE
Practice Address - State:MN
Practice Address - Zip Code:55025-2527
Practice Address - Country:US
Practice Address - Phone:651-464-3425
Practice Address - Fax:651-464-5432
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-04
Last Update Date:2013-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND121371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty