Provider Demographics
NPI:1194121145
Name:KNIPPENBERG, LUCY (DDS)
Entity type:Individual
Prefix:DR
First Name:LUCY
Middle Name:
Last Name:KNIPPENBERG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:575 RILEY HOSPITAL DR STE 4205
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-5272
Mailing Address - Country:US
Mailing Address - Phone:309-201-7062
Mailing Address - Fax:
Practice Address - Street 1:575 RILEY HOSPITAL DR STE 4205
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-5272
Practice Address - Country:US
Practice Address - Phone:309-201-7062
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-18
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12012140A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist