Organization
JEFFREY OWEN KNUTZEN, D.D.S., P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LISA S. KNUTZEN (VICE PRESIDENT)
(417) 623-6202
Entity
Organization
Contact information
Practice address
1819 W 32ND ST, JOPLIN, MO 64804-1528
(417) 623-6202
(417) 624-4521
Mailing address
1819 W 32ND ST, JOPLIN, MO 64804-1528
(417) 623-6202
(417) 624-4521
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
014997
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
402752018
—
MO
05
—
4054863801
—
KS
Enumeration date
06/11/2009
Last updated
06/11/2009
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