Provider Demographics
NPI:1578573945
Name:KNIERIM, ROBERT SCOTT (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:SCOTT
Last Name:KNIERIM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:R
Other - Middle Name:SCOTT
Other - Last Name:KNIERIM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:259 HYDRAULIC RIDGE RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22901-8128
Mailing Address - Country:US
Mailing Address - Phone:434-973-1222
Mailing Address - Fax:434-973-2255
Practice Address - Street 1:259 HYDRAULIC RIDGE ROAD
Practice Address - Street 2:SUITE 203
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22901-8974
Practice Address - Country:US
Practice Address - Phone:434-973-1222
Practice Address - Fax:434-973-2255
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401005008122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist