Provider Demographics
NPI:1770698474
Name:KNOX, ANITA MARIE (DDS)
Entity type:Individual
Prefix:MRS
First Name:ANITA
Middle Name:MARIE
Last Name:KNOX
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:MRS
Other - First Name:ANITA
Other - Middle Name:MARIE
Other - Last Name:KNOX
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:15531 KUYKENDAHL RD
Mailing Address - Street 2:STE 180
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77090-3645
Mailing Address - Country:US
Mailing Address - Phone:832-387-8111
Mailing Address - Fax:832-387-8111
Practice Address - Street 1:2722 SANDCREST DR
Practice Address - Street 2:
Practice Address - City:MANVEL
Practice Address - State:TX
Practice Address - Zip Code:77578-3245
Practice Address - Country:US
Practice Address - Phone:832-387-8111
Practice Address - Fax:832-387-8111
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2013-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX205351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX147855405Medicaid
TX173604301Medicaid
TX147855402Medicaid
TX147855401Medicaid
TX147855404Medicaid
TX147855403Medicaid