Provider Demographics
NPI:1871152322
Name:MCKNIGHT, TANIA M (RDH)
Entity type:Individual
Prefix:
First Name:TANIA
Middle Name:M
Last Name:MCKNIGHT
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7636 TOWER RD
Mailing Address - Street 2:
Mailing Address - City:SIREN
Mailing Address - State:WI
Mailing Address - Zip Code:54872-8301
Mailing Address - Country:US
Mailing Address - Phone:715-497-3335
Mailing Address - Fax:
Practice Address - Street 1:26425 LAKELAND AVE S
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:WI
Practice Address - Zip Code:54893-8343
Practice Address - Country:US
Practice Address - Phone:715-866-4271
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-09
Last Update Date:2019-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1002920124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist