Provider Demographics
NPI:1487095220
Name:DR. JAMES KNUTSON
Entity type:Organization
Organization Name:DR. JAMES KNUTSON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DDS
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:H
Authorized Official - Last Name:KNUTSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:320-679-2435
Mailing Address - Street 1:119 LAKE ST S
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MORA
Mailing Address - State:MN
Mailing Address - Zip Code:55051-1576
Mailing Address - Country:US
Mailing Address - Phone:320-679-2435
Mailing Address - Fax:320-679-0401
Practice Address - Street 1:119 LAKE ST S
Practice Address - Street 2:SUITE 1
Practice Address - City:MORA
Practice Address - State:MN
Practice Address - Zip Code:55051-1576
Practice Address - Country:US
Practice Address - Phone:320-679-2435
Practice Address - Fax:320-679-0401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-09
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND11152122300000X
MN8314122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty