Provider Demographics
NPI:1669588208
Name:CARMELLA M. KNOERNSCHILD, DDS, PA
Entity type:Organization
Organization Name:CARMELLA M. KNOERNSCHILD, DDS, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST/OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:CARMELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:KNOERNSCHILD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:479-968-2138
Mailing Address - Street 1:2015 W PARKWAY DR
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72802-2108
Mailing Address - Country:US
Mailing Address - Phone:479-968-2138
Mailing Address - Fax:479-890-6796
Practice Address - Street 1:2015 W PARKWAY DR
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:AR
Practice Address - Zip Code:72802-2108
Practice Address - Country:US
Practice Address - Phone:479-968-2138
Practice Address - Fax:479-890-6796
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR28781223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty