Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 7353 | CO |
NPI | 1003828930 |
---|---|
Provider Name | Kurt Winston Knechtel |
First Address | Longmont, CO 80501 |
Second Address | Longmont, CO 80501 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/08/2006 |
Last Update Date | 08/07/2007 |