Provider Demographics
NPI:1356534234
Name:KNUPPEL, RAYMOND FREDRICK JR (DDS)
Entity type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:FREDRICK
Last Name:KNUPPEL
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 S ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78624-4107
Mailing Address - Country:US
Mailing Address - Phone:512-897-4562
Mailing Address - Fax:
Practice Address - Street 1:408 S ADAMS ST
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:TX
Practice Address - Zip Code:78624-4107
Practice Address - Country:US
Practice Address - Phone:512-897-4562
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-23
Last Update Date:2012-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX83501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice