Provider Demographics
NPI:1255430567
Name:KNIBBE, MARK ANDREW (MD DDS)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:ANDREW
Last Name:KNIBBE
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Gender:M
Credentials:MD DDS
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Mailing Address - Street 1:330 THOMAS MORE PKWY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CRESTVIEW HILLS
Mailing Address - State:KY
Mailing Address - Zip Code:41017
Mailing Address - Country:US
Mailing Address - Phone:859-578-9000
Mailing Address - Fax:859-578-9815
Practice Address - Street 1:330 THOMAS MORE PKWY
Practice Address - Street 2:SUITE 101
Practice Address - City:CRESTVIEW HILLS
Practice Address - State:KY
Practice Address - Zip Code:41017
Practice Address - Country:US
Practice Address - Phone:859-578-9000
Practice Address - Fax:859-578-9815
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2011-10-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KY273981223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY27398OtherMED
KY6501OtherDENTAL
KY6501OtherDENTAL
E28224Medicare UPIN