Provider Demographics
NPI:1659460491
Name:CHARLES F KNEEDLER DDS LTD
Entity Type:Organization
Organization Name:CHARLES F KNEEDLER DDS LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:FORREST
Authorized Official - Last Name:KNEEDLER
Authorized Official - Suffix:
Authorized Official - Credentials:DENTIST
Authorized Official - Phone:618-234-3700
Mailing Address - Street 1:3600 N ILLINOIS
Mailing Address - Street 2:
Mailing Address - City:SWANSEA
Mailing Address - State:IL
Mailing Address - Zip Code:62226
Mailing Address - Country:US
Mailing Address - Phone:618-234-3700
Mailing Address - Fax:618-234-4076
Practice Address - Street 1:3600 N ILLINOIS
Practice Address - Street 2:
Practice Address - City:SWANSEA
Practice Address - State:IL
Practice Address - Zip Code:62226
Practice Address - Country:US
Practice Address - Phone:618-234-3700
Practice Address - Fax:618-234-4076
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty