Provider Demographics
NPI:1336358043
Name:KNIGHT, EDWARD T (DDS)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:T
Last Name:KNIGHT
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 1:5604 EASTMAN AVE
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640-2762
Mailing Address - Country:US
Mailing Address - Phone:989-835-6767
Mailing Address - Fax:989-835-1239
Practice Address - Street 1:1306 HELEN ST
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-3334
Practice Address - Country:US
Practice Address - Phone:989-837-1781
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901016816122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist