Provider Demographics
NPI:1558396671
Name:KNOWLTON, DONNA C (DDS)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:C
Last Name:KNOWLTON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:DONNA
Other - Middle Name:C
Other - Last Name:ROSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:812 PINE VALLEY CT
Mailing Address - Street 2:
Mailing Address - City:WEDDINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28104-7414
Mailing Address - Country:US
Mailing Address - Phone:757-753-6086
Mailing Address - Fax:
Practice Address - Street 1:345 E 24TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-4020
Practice Address - Country:US
Practice Address - Phone:212-998-9454
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8025122300000X, 1223G0001X
NY0517501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5901858Medicaid
0TH00Medicare UPIN