Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | D14206 | MN |
NPI | 1093277592 |
---|---|
Provider Name | Dr. Quentin Knutson |
First Address | Saint Paul, MN 55112-1478 |
Second Address | Saint Paul, MN 55112-1478 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2019 |
Last Update Date | 09/12/2021 |