Provider Demographics
NPI:1558344325
Name:KNOPP, BRUNO (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRUNO
Middle Name:
Last Name:KNOPP
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2757 THE MEWS
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-2617
Mailing Address - Country:US
Mailing Address - Phone:847-272-2874
Mailing Address - Fax:
Practice Address - Street 1:6051 W BELMONT AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60634-5116
Practice Address - Country:US
Practice Address - Phone:773-836-1000
Practice Address - Fax:773-836-1010
Is Sole Proprietor?:No
Enumeration Date:2005-11-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL190264961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice