Provider Demographics
NPI:1649374083
Name:KNITER, ROMAN (DDS)
Entity type:Individual
Prefix:DR
First Name:ROMAN
Middle Name:
Last Name:KNITER
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 1:3156 DONA MARTA DR
Mailing Address - Street 2:
Mailing Address - City:STUDIO CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91604-4326
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:16861 VENTURA BLVD
Practice Address - Street 2:SUITE 302
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-1708
Practice Address - Country:US
Practice Address - Phone:818-986-8060
Practice Address - Fax:818-986-8066
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA394301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice