Provider Demographics
NPI:1770793374
Name:KNOELL, ALEXANDER NATHAN (DMD)
Entity type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:NATHAN
Last Name:KNOELL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 S WASHINGTON AVE
Mailing Address - Street 2:PO BOX 266
Mailing Address - City:HENDERSON
Mailing Address - State:TN
Mailing Address - Zip Code:38340-2323
Mailing Address - Country:US
Mailing Address - Phone:731-435-1253
Mailing Address - Fax:731-435-1254
Practice Address - Street 1:136 S WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:TN
Practice Address - Zip Code:38340-2323
Practice Address - Country:US
Practice Address - Phone:731-435-1253
Practice Address - Fax:731-435-1254
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2009-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN79521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice