Provider Demographics
NPI:1487098109
Name:DAN A. KNELLINGER DMD, PA
Entity type:Organization
Organization Name:DAN A. KNELLINGER DMD, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:KNELLINGER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:727-785-3383
Mailing Address - Street 1:1246 FLORIDA AVE
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34683-4316
Mailing Address - Country:US
Mailing Address - Phone:727-785-3383
Mailing Address - Fax:727-785-3378
Practice Address - Street 1:1246 FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34683-4316
Practice Address - Country:US
Practice Address - Phone:727-785-3383
Practice Address - Fax:727-785-3378
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-24
Last Update Date:2013-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 18261332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment