Provider Demographics
NPI:1710335906
Name:KNUDSEN, MITCHELL J (DDS)
Entity Type:Individual
Prefix:
First Name:MITCHELL
Middle Name:J
Last Name:KNUDSEN
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 1:1108 W 7TH ST
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NE
Mailing Address - Zip Code:68787-1951
Mailing Address - Country:US
Mailing Address - Phone:402-375-2889
Mailing Address - Fax:
Practice Address - Street 1:1108 W 7TH ST
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NE
Practice Address - Zip Code:68787
Practice Address - Country:US
Practice Address - Phone:402-375-2889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-27
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE7295122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist