Provider Demographics
NPI:1558304675
Name:KNUDSON, ROLF O (DMD)
Entity Type:Individual
Prefix:DR
First Name:ROLF
Middle Name:O
Last Name:KNUDSON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79 W MAIN ST
Mailing Address - Street 2:POBOX 407
Mailing Address - City:BRADFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03221-3308
Mailing Address - Country:US
Mailing Address - Phone:603-632-7084
Mailing Address - Fax:
Practice Address - Street 1:79 W MAIN ST
Practice Address - Street 2:
Practice Address - City:BRADFORD
Practice Address - State:NH
Practice Address - Zip Code:03221-3308
Practice Address - Country:US
Practice Address - Phone:603-632-7084
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH11941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice