1255957585 NPI number — DR. ASHLEY RENEE GABREK KNAPKE DMD

Table of content: DR. ASHLEY RENEE GABREK KNAPKE DMD (NPI 1255957585)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255957585 NPI number — DR. ASHLEY RENEE GABREK KNAPKE DMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KNAPKE
Provider First Name:
ASHLEY
Provider Middle Name:
RENEE GABREK
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DMD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1255957585
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/13/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11219 MALLORY CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROANOKE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46783-8602
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
260-452-4233
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9121 ILLINOIS RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT WAYNE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46804-5753
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
260-434-0099
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/23/2020

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  12013392A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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