Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 16313 | MD |
N | 1223G0001X | General Practice | 16313 | MD |
N | 213EG0000X | General Practice | 16313 | MD |
NPI | 1003270612 |
---|---|
Provider Name | Dr. Dominique Knox |
First Address | Washington, DC 20003-3529 |
Second Address | Waldorf, MD 20602-2190 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/04/2016 |
Last Update Date | 13/05/2019 |