Provider Demographics
NPI:1932204153
Name:KNECHT, NATHANIEL F (DDS)
Entity Type:Individual
Prefix:DR
First Name:NATHANIEL
Middle Name:F
Last Name:KNECHT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 SANTA FE DR
Mailing Address - Street 2:SUITE 105
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-5138
Mailing Address - Country:US
Mailing Address - Phone:760-436-9292
Mailing Address - Fax:760-436-9332
Practice Address - Street 1:320 SANTA FE DR
Practice Address - Street 2:SUITE 105
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-5138
Practice Address - Country:US
Practice Address - Phone:760-436-9292
Practice Address - Fax:760-436-9332
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2010-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO83871223G0001X
CA592571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice