Provider Demographics
NPI:1669601340
Name:KNIERIM, ERIN AMBROSE (DMD, MS)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:AMBROSE
Last Name:KNIERIM
Suffix:
Gender:F
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3036 W SYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43613-4128
Mailing Address - Country:US
Mailing Address - Phone:419-474-0733
Mailing Address - Fax:
Practice Address - Street 1:3036 W SYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43613-4128
Practice Address - Country:US
Practice Address - Phone:419-474-0733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-02
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-0229541223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3116372Medicaid