Provider Demographics
NPI:1184745812
Name:KNECHT, BRUCE GREGORY (DMD,PA)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:GREGORY
Last Name:KNECHT
Suffix:
Gender:M
Credentials:DMD,PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6532 N STATE ROAD 7
Mailing Address - Street 2:
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33073-3624
Mailing Address - Country:US
Mailing Address - Phone:954-427-8000
Mailing Address - Fax:954-427-8189
Practice Address - Street 1:6532 N STATE ROAD 7
Practice Address - Street 2:
Practice Address - City:COCONUT CREEK
Practice Address - State:FL
Practice Address - Zip Code:33073-3624
Practice Address - Country:US
Practice Address - Phone:954-427-8000
Practice Address - Fax:954-427-8189
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN00128411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice