Provider Demographics
NPI:1942420880
Name:KNUDSEN, DEAN DAVID (DDS)
Entity Type:Individual
Prefix:DR
First Name:DEAN
Middle Name:DAVID
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 1:1120 COLLEGE DR
Mailing Address - Street 2:SUITE 204
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58501-1225
Mailing Address - Country:US
Mailing Address - Phone:701-258-3308
Mailing Address - Fax:701-258-3178
Practice Address - Street 1:1120 COLLEGE DR
Practice Address - Street 2:SUITE 204
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-1225
Practice Address - Country:US
Practice Address - Phone:701-258-3308
Practice Address - Fax:701-258-3178
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1738122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist