Provider Demographics
NPI:1720650450
Name:KNX DENTAL ENTERPRISES, LLC
Entity Type:Organization
Organization Name:KNX DENTAL ENTERPRISES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:CLAY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:515-573-7601
Mailing Address - Street 1:401 E ROBINSON ST
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:50138-2004
Mailing Address - Country:US
Mailing Address - Phone:641-828-8778
Mailing Address - Fax:
Practice Address - Street 1:1905 N 15TH ST
Practice Address - Street 2:
Practice Address - City:FORT DODGE
Practice Address - State:IA
Practice Address - Zip Code:50501-7604
Practice Address - Country:US
Practice Address - Phone:515-573-7601
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-13
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1223G0001Medicaid
IA193400000Medicaid
IA193400000XMedicaid