Provider Demographics
NPI:1649441890
Name:KNAPE, KERRY ROBERT (DDS)
Entity type:Individual
Prefix:DR
First Name:KERRY
Middle Name:ROBERT
Last Name:KNAPE
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 1:100 S MAIN STREET
Mailing Address - Street 2:PO BOX 521
Mailing Address - City:NORTH LIBERTY
Mailing Address - State:IN
Mailing Address - Zip Code:46554
Mailing Address - Country:US
Mailing Address - Phone:574-656-8175
Mailing Address - Fax:574-656-8137
Practice Address - Street 1:100 S MAIN STREET
Practice Address - Street 2:
Practice Address - City:NORTH LIBERTY
Practice Address - State:IN
Practice Address - Zip Code:46554
Practice Address - Country:US
Practice Address - Phone:574-656-8175
Practice Address - Fax:574-656-8137
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-17
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12007875A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist