Provider Demographics
NPI:1396895702
Name:KNIGHT, MICHAEL (DDS)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:KNIGHT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:VENSSA
Other - Middle Name:
Other - Last Name:KNIGHT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:3080 WEST PINEBROOK ROAD
Mailing Address - Street 2:SUITE #2000
Mailing Address - City:PARK CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84098-5451
Mailing Address - Country:US
Mailing Address - Phone:435-649-6688
Mailing Address - Fax:435-649-0654
Practice Address - Street 1:3080 WEST PINEBROOK ROAD
Practice Address - Street 2:SUITE #2000
Practice Address - City:PARK CITY
Practice Address - State:UT
Practice Address - Zip Code:84098-5451
Practice Address - Country:US
Practice Address - Phone:435-649-6688
Practice Address - Fax:435-649-0654
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT3637301223G0001X
UT380199332B00000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies