Provider Demographics
NPI:1891940789
Name:KNUTE J HERNAS DDS PS
Entity Type:Organization
Organization Name:KNUTE J HERNAS DDS PS
Other - Org Name:HERNAS DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KNUTE
Authorized Official - Middle Name:J
Authorized Official - Last Name:HERNAS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:509-725-6281
Mailing Address - Street 1:100 3RD ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:DAVENPORT
Mailing Address - State:WA
Mailing Address - Zip Code:99122-5008
Mailing Address - Country:US
Mailing Address - Phone:509-725-6281
Mailing Address - Fax:509-725-6282
Practice Address - Street 1:100 3RD ST
Practice Address - Street 2:SUITE 3
Practice Address - City:DAVENPORT
Practice Address - State:WA
Practice Address - Zip Code:99122-5008
Practice Address - Country:US
Practice Address - Phone:509-725-6281
Practice Address - Fax:509-725-6282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-19
Last Update Date:2008-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA601835986261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5036009Medicaid