Provider Demographics
NPI:1720291826
Name:KNITER, SINAIDA (DDS)
Entity Type:Individual
Prefix:
First Name:SINAIDA
Middle Name:
Last Name:KNITER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8205 SANTA MONICA BLVD STE 12
Mailing Address - Street 2:
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90046-5963
Mailing Address - Country:US
Mailing Address - Phone:323-654-1100
Mailing Address - Fax:
Practice Address - Street 1:8205 SANTA MONICA BLVD STE 12
Practice Address - Street 2:
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90046-5963
Practice Address - Country:US
Practice Address - Phone:323-654-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA371231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB37123-01Medicaid
CA973388OtherUNITED CONCORDIA PROVIDER