Provider Demographics
NPI:1982685947
Name:KNUTSON, JOEL CALEB (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:CALEB
Last Name:KNUTSON
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:PSC 3, BOX 127
Mailing Address - Street 2:
Mailing Address - City:APO AP
Mailing Address - State:OSAN AB
Mailing Address - Zip Code:96266
Mailing Address - Country:KR
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:PSC 3, BOX 127
Practice Address - Street 2:
Practice Address - City:APO AP
Practice Address - State:OSAN AB
Practice Address - Zip Code:96266
Practice Address - Country:KR
Practice Address - Phone:011-823-1661
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5001823 - 0151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice