Provider Demographics
NPI:1972650349
Name:KNIGHT, JOHNNIE LEON (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOHNNIE
Middle Name:LEON
Last Name:KNIGHT
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 1:7630 OLD HINKLEVILLE RD
Mailing Address - Street 2:
Mailing Address - City:WEST PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42086-9519
Mailing Address - Country:US
Mailing Address - Phone:270-744-8757
Mailing Address - Fax:270-744-8757
Practice Address - Street 1:7630 OLD HINKLEVILLE RD
Practice Address - Street 2:
Practice Address - City:WEST PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42086-9519
Practice Address - Country:US
Practice Address - Phone:270-744-8757
Practice Address - Fax:270-744-8757
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4748122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY4748OtherSTATE ID