Provider Demographics
NPI:1023061538
Name:KNUDSEN DENTISTRY, P.L.C.
Entity type:Organization
Organization Name:KNUDSEN DENTISTRY, P.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER, KNUDSEN DENTISTRY, PLC
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:KNUDSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:906-786-3936
Mailing Address - Street 1:1830 LUDINGTON ST
Mailing Address - Street 2:
Mailing Address - City:ESCANABA
Mailing Address - State:MI
Mailing Address - Zip Code:49829-2739
Mailing Address - Country:US
Mailing Address - Phone:906-786-3936
Mailing Address - Fax:
Practice Address - Street 1:1830 LUDINGTON ST
Practice Address - Street 2:
Practice Address - City:ESCANABA
Practice Address - State:MI
Practice Address - Zip Code:49829-2739
Practice Address - Country:US
Practice Address - Phone:906-786-3936
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010170521223G0001X
MI29010094311223G0001X
MI29010167061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty