Provider Demographics
NPI:1255822169
Name:KNIGHTON, DANIEL KIRK (DDS)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:KIRK
Last Name:KNIGHTON
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 1:101 N INDUSTRIAL RD STE A
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38801-3441
Mailing Address - Country:US
Mailing Address - Phone:662-680-3383
Mailing Address - Fax:662-680-4745
Practice Address - Street 1:101 N INDUSTRIAL RD STE A
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-3441
Practice Address - Country:US
Practice Address - Phone:662-680-3383
Practice Address - Fax:662-680-4745
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-25
Last Update Date:2018-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3988-181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice