Provider Demographics
NPI:1881687283
Name:KNORR, JEFFREY COLLIER (DDS, MSBA)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:COLLIER
Last Name:KNORR
Suffix:
Gender:M
Credentials:DDS, MSBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50150 HEDGEWAY DR
Mailing Address - Street 2:
Mailing Address - City:SHELBY TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48317-1829
Mailing Address - Country:US
Mailing Address - Phone:586-242-5721
Mailing Address - Fax:
Practice Address - Street 1:35050 23 MILE RD
Practice Address - Street 2:SUITE C
Practice Address - City:NEW BALTIMORE
Practice Address - State:MI
Practice Address - Zip Code:48047-3606
Practice Address - Country:US
Practice Address - Phone:586-725-2400
Practice Address - Fax:586-725-2405
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-31
Last Update Date:2022-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010130881223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MID801975OtherBCBS DENTAL
MI970E04300OtherBCBS-MI
MIMI7961001Medicare UPIN
MID801975OtherBCBS DENTAL