Provider Demographics
NPI:1194052084
Name:KNIPPER, EMMETT TODD (DDS)
Entity type:Individual
Prefix:DR
First Name:EMMETT
Middle Name:TODD
Last Name:KNIPPER
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 1:595 BUCK AVE STE K
Mailing Address - Street 2:
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95688-3642
Mailing Address - Country:US
Mailing Address - Phone:707-448-7131
Mailing Address - Fax:707-448-8219
Practice Address - Street 1:595 BUCK AVE STE K
Practice Address - Street 2:
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95688-3642
Practice Address - Country:US
Practice Address - Phone:707-448-7131
Practice Address - Fax:707-448-8219
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-12
Last Update Date:2009-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA281771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice