Provider Demographics
NPI:1063709996
Name:KNECHT AND WOLF, DDS, P.C.
Entity type:Organization
Organization Name:KNECHT AND WOLF, DDS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:KNECHT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:989-725-7825
Mailing Address - Street 1:222 N PARK ST
Mailing Address - Street 2:
Mailing Address - City:OWOSSO
Mailing Address - State:MI
Mailing Address - Zip Code:48867-3042
Mailing Address - Country:US
Mailing Address - Phone:989-725-7825
Mailing Address - Fax:989-725-7570
Practice Address - Street 1:222 N PARK ST
Practice Address - Street 2:
Practice Address - City:OWOSSO
Practice Address - State:MI
Practice Address - Zip Code:48867-3042
Practice Address - Country:US
Practice Address - Phone:989-725-7825
Practice Address - Fax:989-725-7570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-29
Last Update Date:2011-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty