Provider Demographics
NPI:1841871845
Name:KNUTSON FAMILY DENTAL
Entity type:Organization
Organization Name:KNUTSON FAMILY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KAITLIN
Authorized Official - Middle Name:
Authorized Official - Last Name:KNUTSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:715-523-9874
Mailing Address - Street 1:N7536 COUNTY ROAD J
Mailing Address - Street 2:
Mailing Address - City:BELDENVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:54003-5418
Mailing Address - Country:US
Mailing Address - Phone:715-523-9874
Mailing Address - Fax:
Practice Address - Street 1:501 LUCAS LN
Practice Address - Street 2:
Practice Address - City:ELLSWORTH
Practice Address - State:WI
Practice Address - Zip Code:54011-2800
Practice Address - Country:US
Practice Address - Phone:715-523-9874
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-20
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental