Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204E00000X | Oral & Maxillofacial Surgeon | DS023724L | PA |
NPI | 1578677688 |
---|---|
Provider Name | Dr. Kenneth Dean Knipe |
First Address | Hershey, PA 17033-1715 |
Second Address | Hershey, PA 17033-1715 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T30392 | (02) |