Provider Demographics
NPI:1578763116
Name:KNORR, SHAWN DONALD (DDS)
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:DONALD
Last Name:KNORR
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 1:1015 GREELEY AVE N
Mailing Address - Street 2:
Mailing Address - City:GLENCOE
Mailing Address - State:MN
Mailing Address - Zip Code:55336-2129
Mailing Address - Country:US
Mailing Address - Phone:320-864-3129
Mailing Address - Fax:320-864-4920
Practice Address - Street 1:1015 GREELEY AVE N
Practice Address - Street 2:
Practice Address - City:GLENCOE
Practice Address - State:MN
Practice Address - Zip Code:55336-2129
Practice Address - Country:US
Practice Address - Phone:320-864-3129
Practice Address - Fax:320-864-4920
Is Sole Proprietor?:No
Enumeration Date:2007-07-23
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND124561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice