Provider Demographics
NPI:1396714168
Name:KNUTSON, KRISTINE ANNETTE (DDS)
Entity type:Individual
Prefix:DR
First Name:KRISTINE
Middle Name:ANNETTE
Last Name:KNUTSON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12280 CORTE SABIO UNIT 4205
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128-4593
Mailing Address - Country:US
Mailing Address - Phone:507-271-7789
Mailing Address - Fax:
Practice Address - Street 1:BRANCH DENTAL CLINIC, MCAS, MIRAMAR
Practice Address - Street 2:BLDG 2495 MITSCHEN WAY
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92145-2102
Practice Address - Country:US
Practice Address - Phone:858-577-1825
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2009-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN13502122300000X
CA54053122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist