Provider Demographics
NPI:1689789182
Name:KNOTEK, GEORGIA ANN (DDS)
Entity Type:Individual
Prefix:DR
First Name:GEORGIA
Middle Name:ANN
Last Name:KNOTEK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1852 FIELDS BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46140-4006
Mailing Address - Country:US
Mailing Address - Phone:317-462-5181
Mailing Address - Fax:
Practice Address - Street 1:1852 FIELDS BLVD STE B
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:IN
Practice Address - Zip Code:46140-4006
Practice Address - Country:US
Practice Address - Phone:317-462-5181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120092421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice