Provider Demographics
NPI:1588766513
Name:KNOWLES, NORMAN DAVID (DMD)
Entity type:Individual
Prefix:DR
First Name:NORMAN
Middle Name:DAVID
Last Name:KNOWLES
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1511 S 25TH ST STE B
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34947-4779
Mailing Address - Country:US
Mailing Address - Phone:772-464-7214
Mailing Address - Fax:772-464-9946
Practice Address - Street 1:1511 S 25TH ST STE B
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34947-4779
Practice Address - Country:US
Practice Address - Phone:772-464-7214
Practice Address - Fax:772-464-9946
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2017-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 00123371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDN12337OtherSTATE LICENSE