Provider Demographics
NPI:1487784013
Name:CARL KNOX DDS PLLC
Entity type:Organization
Organization Name:CARL KNOX DDS PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:LARUE
Authorized Official - Last Name:KNOX
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:253-531-0638
Mailing Address - Street 1:14818 PACIFIC AVE
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98444
Mailing Address - Country:US
Mailing Address - Phone:253-531-0638
Mailing Address - Fax:253-536-7928
Practice Address - Street 1:14818 PACIFIC AVE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98444
Practice Address - Country:US
Practice Address - Phone:253-531-0638
Practice Address - Fax:253-536-7928
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA5943122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0143OtherWASHINGTON DENTAL SERVICE
614482OtherUNITED CONCORDIA INSURANC
129840361OtherAMERICAN DENTAL ASSOCIATI
WA5092507Medicaid
KN7070OtherREGENCE BLUE CROSS BLUE S