Provider Demographics
NPI:1447655956
Name:DR. BENJAMIN W. KNAAK
Entity type:Organization
Organization Name:DR. BENJAMIN W. KNAAK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:W
Authorized Official - Last Name:KNAAK
Authorized Official - Suffix:
Authorized Official - Credentials:DMD DDS
Authorized Official - Phone:706-235-6011
Mailing Address - Street 1:2201 J L TODD DR
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30161-5064
Mailing Address - Country:US
Mailing Address - Phone:706-235-6011
Mailing Address - Fax:706-235-6352
Practice Address - Street 1:2201 J L TODD DR
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30161-5064
Practice Address - Country:US
Practice Address - Phone:706-235-6011
Practice Address - Fax:706-235-6352
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-27
Last Update Date:2014-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty