Provider Demographics
NPI:1124163779
Name:ANNA KNAPP FAMILY DENTISTRY PA
Entity type:Organization
Organization Name:ANNA KNAPP FAMILY DENTISTRY PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:C
Authorized Official - Last Name:RICKER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:843-849-7609
Mailing Address - Street 1:1041 JOHNNIE DODDS BLVD
Mailing Address - Street 2:STE 4A
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464
Mailing Address - Country:US
Mailing Address - Phone:843-849-7609
Mailing Address - Fax:843-849-7612
Practice Address - Street 1:1041 JOHNNIE DODDS BLVD
Practice Address - Street 2:STE 4A
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464
Practice Address - Country:US
Practice Address - Phone:843-849-7609
Practice Address - Fax:843-849-7612
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3283122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZ32830Medicaid