| Jeffrey Owen Knutzen, D.d.s., P.c. | |
|
1819 W 32nd St Joplin MO 64804-1528 | |
| (417) 623-6202 | |
| (417) 624-4521 |
| Full Name | Jeffrey Owen Knutzen, D.d.s., P.c. |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 1819 W 32nd St, Joplin, Missouri |
| Authorized Official Name and Position | Lisa S. Knutzen (VICE PRESIDENT) |
| Authorized Official Contact | 4176236202 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Jeffrey Owen Knutzen, D.d.s., P.c. 1819 W 32nd St Joplin MO 64804-1528 Ph: (417) 623-6202 | Jeffrey Owen Knutzen, D.d.s., P.c. 1819 W 32nd St Joplin MO 64804-1528 Ph: (417) 623-6202 |
| NPI Number | 1669609137 |
|---|---|
| Provider Enumeration Date | 06/11/2009 |
| Last Update Date | 06/11/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1669609137 | NPI | - | NPPES |
| 4054863801 | Medicaid | KS | |
| 402752018 | Medicaid | MO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | 014997 (Missouri) | Primary |
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