Provider Demographics
NPI:1487035606
Name:KNITTEL, JEFFREY ROBERT (DDS, MD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:ROBERT
Last Name:KNITTEL
Suffix:
Gender:M
Credentials:DDS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 WASHINGTON RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT DORA
Mailing Address - State:FL
Mailing Address - Zip Code:32757-3525
Mailing Address - Country:US
Mailing Address - Phone:352-505-2108
Mailing Address - Fax:
Practice Address - Street 1:2600 WASHINGTON RD
Practice Address - Street 2:
Practice Address - City:MOUNT DORA
Practice Address - State:FL
Practice Address - Zip Code:32757-3525
Practice Address - Country:US
Practice Address - Phone:352-505-2108
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-12
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDRP#14341223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery