Provider Demographics
NPI:1578638227
Name:KNOX, BLAINE LEROY (DDS)
Entity Type:Individual
Prefix:DR
First Name:BLAINE
Middle Name:LEROY
Last Name:KNOX
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 1:3705 WARNER PARK CIR
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66503-3108
Mailing Address - Country:US
Mailing Address - Phone:785-239-4174
Mailing Address - Fax:785-239-7245
Practice Address - Street 1:600 CAISSON HILL ROAD
Practice Address - Street 2:
Practice Address - City:FT. RILEY
Practice Address - State:KS
Practice Address - Zip Code:66442-5043
Practice Address - Country:US
Practice Address - Phone:785-239-7241
Practice Address - Fax:785-239-7245
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 105501223G0001X
VA04010064411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1223G0001XDental ProvidersDentistGeneral Practice