1427193382 NPI number — DR. CARL LARUE KNOX DDS

Table of content: DR. CARL LARUE KNOX DDS (NPI 1427193382)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427193382 NPI number — DR. CARL LARUE KNOX DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KNOX
Provider First Name:
CARL
Provider Middle Name:
LARUE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KNOX
Provider Other First Name:
CARL
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
DDS PLLC
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1427193382
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14818 PACIFIC AVE S
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TACOMA
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98444
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
253-531-0638
Provider Business Mailing Address Fax Number:
253-536-7928

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14818 PACIFIC AVE S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TACOMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98444
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-531-0638
Provider Business Practice Location Address Fax Number:
253-536-7928
Provider Enumeration Date:
02/20/2007

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: 122300000X , with the licence number:  5943 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0143 . This is a "WASHINGTON DENTAL SERVICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 614482 . This is a "UNITED CONCORDIA INS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 129840361 . This is a "AMERICAN DENTAL ASSOCIATI" identifier . This identifiers is of the category "OTHER".
  • Identifier: KN707 . This is a "REGENCE BLUE CROSS BLUE S" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5092507 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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