Provider Demographics
NPI:1518250125
Name:MCKNIGHT, MATTHEW GREGORY (DDS, MD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:GREGORY
Last Name:MCKNIGHT
Suffix:
Gender:M
Credentials:DDS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 COURTYARD DR
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60174-1463
Mailing Address - Country:US
Mailing Address - Phone:630-377-7077
Mailing Address - Fax:
Practice Address - Street 1:605 COURTYARD DR
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174-1463
Practice Address - Country:US
Practice Address - Phone:630-377-7077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-16
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0210028271223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1518250125OtherNPI
IL1215579008OtherNPI CORPORATE