Provider Demographics
NPI:1750382719
Name:KNUTSON, GIL TODD (DDS)
Entity type:Individual
Prefix:DR
First Name:GIL
Middle Name:TODD
Last Name:KNUTSON
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 1:17585 W NORTH AVE
Mailing Address - Street 2:STE 210
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53045-4365
Mailing Address - Country:US
Mailing Address - Phone:262-784-4222
Mailing Address - Fax:262-784-4472
Practice Address - Street 1:17585 W NORTH AVE
Practice Address - Street 2:STE 210
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53045-4365
Practice Address - Country:US
Practice Address - Phone:262-784-4222
Practice Address - Fax:262-784-4472
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2358122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist