Provider Demographics
NPI:1750730958
Name:KNIGHTEN, TERESA MORGAN (RDH)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:MORGAN
Last Name:KNIGHTEN
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:TERESA
Other - Middle Name:
Other - Last Name:KNIGHTEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RDH
Mailing Address - Street 1:920 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ARITON
Mailing Address - State:AL
Mailing Address - Zip Code:36311-5028
Mailing Address - Country:US
Mailing Address - Phone:334-237-2548
Mailing Address - Fax:
Practice Address - Street 1:4405 INNKEEPERS ST
Practice Address - Street 2:
Practice Address - City:FORT RUCKER
Practice Address - State:AL
Practice Address - Zip Code:36362
Practice Address - Country:US
Practice Address - Phone:334-255-3393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-08
Last Update Date:2016-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5187124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist