Provider Demographics
NPI:1568689552
Name:KNIGHT, MARK HENRY (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:HENRY
Last Name:KNIGHT
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 1:1408 W HILL RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48507-4726
Mailing Address - Country:US
Mailing Address - Phone:810-239-8810
Mailing Address - Fax:810-239-8830
Practice Address - Street 1:1408 W HILL RD
Practice Address - Street 2:SUITE A
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-4726
Practice Address - Country:US
Practice Address - Phone:810-239-8810
Practice Address - Fax:810-239-8830
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010164041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice