Provider Demographics
NPI:1013459304
Name:GREENCASTLE HOMETOWN DENTAL DENNIS M KNUTH DDS LLC
Entity type:Organization
Organization Name:GREENCASTLE HOMETOWN DENTAL DENNIS M KNUTH DDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:M
Authorized Official - Last Name:KNUTH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:765-653-4081
Mailing Address - Street 1:1113 INDIANAPOLIS RD
Mailing Address - Street 2:
Mailing Address - City:GREENCASTLE
Mailing Address - State:IN
Mailing Address - Zip Code:46135-2408
Mailing Address - Country:US
Mailing Address - Phone:765-653-4081
Mailing Address - Fax:
Practice Address - Street 1:1113 INDIANAPOLIS RD
Practice Address - Street 2:
Practice Address - City:GREENCASTLE
Practice Address - State:IN
Practice Address - Zip Code:46135-2408
Practice Address - Country:US
Practice Address - Phone:765-653-4081
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-17
Last Update Date:2016-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12011336122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty