Provider Demographics
NPI:1740380211
Name:KNAUER, JEFFREY KEITH (DDS)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:KEITH
Last Name:KNAUER
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 1:2663 SANDY PLAINS ROAD
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066
Mailing Address - Country:US
Mailing Address - Phone:770-977-0827
Mailing Address - Fax:770-973-6764
Practice Address - Street 1:2663 SANDY PLAINS ROAD
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30066
Practice Address - Country:US
Practice Address - Phone:770-977-0827
Practice Address - Fax:770-973-6764
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA90651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice