Provider Demographics
NPI:1386747533
Name:MICHAEL D. KNIGHT, D.M.D.
Entity type:Organization
Organization Name:MICHAEL D. KNIGHT, D.M.D.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR (DENTIST)
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:KNIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:256-880-1884
Mailing Address - Street 1:1108 GLENEAGLES DR SW
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-6404
Mailing Address - Country:US
Mailing Address - Phone:256-880-1884
Mailing Address - Fax:256-880-1886
Practice Address - Street 1:1108 GLENEAGLES DR SW
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-6404
Practice Address - Country:US
Practice Address - Phone:256-880-1884
Practice Address - Fax:256-880-1886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-06
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL32611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL630800121Medicare UPIN