Provider Demographics
NPI:1043499809
Name:R. SCOTT KNIERIM DDS
Entity type:Organization
Organization Name:R. SCOTT KNIERIM DDS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:R.
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:KNIERIM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:434-973-1222
Mailing Address - Street 1:259 HYDRAULIC RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22901-8128
Mailing Address - Country:US
Mailing Address - Phone:434-973-1222
Mailing Address - Fax:434-973-2255
Practice Address - Street 1:259 HYDRAULIC RIDGE RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22901-8128
Practice Address - Country:US
Practice Address - Phone:434-973-1222
Practice Address - Fax:434-973-2255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-29
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA50081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty