Provider Demographics
NPI:1770100216
Name:KNOWLTON, JENNIFER (DMD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:
Last Name:KNOWLTON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3050 CHORT ALY
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-9350
Mailing Address - Country:US
Mailing Address - Phone:321-217-6778
Mailing Address - Fax:
Practice Address - Street 1:1100 N ALAFAYA TRL
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32828-5966
Practice Address - Country:US
Practice Address - Phone:407-277-7773
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-01
Last Update Date:2020-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN25047122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist