Provider Demographics
NPI:1720273360
Name:S&R KNITER DENTAL CORPORATION
Entity type:Organization
Organization Name:S&R KNITER DENTAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SINAIDA
Authorized Official - Middle Name:
Authorized Official - Last Name:KNITER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:323-654-1100
Mailing Address - Street 1:8205 SANTA MONICA BLVD STE 12
Mailing Address - Street 2:
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90046-5963
Mailing Address - Country:US
Mailing Address - Phone:323-654-1100
Mailing Address - Fax:323-654-2043
Practice Address - Street 1:8205 SANTA MONICA BLVD STE 12
Practice Address - Street 2:
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90046-5963
Practice Address - Country:US
Practice Address - Phone:323-654-1100
Practice Address - Fax:323-654-2043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-06
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37123261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB37123-01OtherDENTI-CAL