Provider Demographics
NPI:1720392194
Name:KNAUSS, DIETER HERBERT (DMD)
Entity Type:Individual
Prefix:DR
First Name:DIETER
Middle Name:HERBERT
Last Name:KNAUSS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 PLEASANT STREET
Mailing Address - Street 2:
Mailing Address - City:EPPING
Mailing Address - State:NH
Mailing Address - Zip Code:03042
Mailing Address - Country:US
Mailing Address - Phone:603-520-5383
Mailing Address - Fax:
Practice Address - Street 1:1852 CENTRE ST
Practice Address - Street 2:
Practice Address - City:WEST ROXBURY
Practice Address - State:MA
Practice Address - Zip Code:02132-1901
Practice Address - Country:US
Practice Address - Phone:617-325-3700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-28
Last Update Date:2010-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1855490122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist