Provider Demographics
NPI:1609124114
Name:KNOERNSCHILD, CARMELLA (DDS, PA)
Entity Type:Individual
Prefix:DR
First Name:CARMELLA
Middle Name:
Last Name:KNOERNSCHILD
Suffix:
Gender:F
Credentials:DDS, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2015 W PARKWAY DR
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72802-2108
Mailing Address - Country:US
Mailing Address - Phone:479-968-2138
Mailing Address - Fax:
Practice Address - Street 1:2015 W PARKWAY DR
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:AR
Practice Address - Zip Code:72802-2108
Practice Address - Country:US
Practice Address - Phone:479-968-2138
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-15
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR28781223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics