Provider Demographics
NPI:1457543787
Name:KNOWLTON, GEORGE STEPHEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:STEPHEN
Last Name:KNOWLTON
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 1:22540 HARPER AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48080-2941
Mailing Address - Country:US
Mailing Address - Phone:586-771-1771
Mailing Address - Fax:
Practice Address - Street 1:22540 HARPER AVE
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48080-2941
Practice Address - Country:US
Practice Address - Phone:586-771-1771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-10
Last Update Date:2007-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI142411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice