Provider Demographics
NPI:1730380536
Name:BENJAMIN T. KNUTZEN DDS, PC
Entity type:Organization
Organization Name:BENJAMIN T. KNUTZEN DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:KNUTZEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:605-692-9463
Mailing Address - Street 1:2311 YORKSHIRE DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:BROOKINGS
Mailing Address - State:SD
Mailing Address - Zip Code:57006-2446
Mailing Address - Country:US
Mailing Address - Phone:605-692-9463
Mailing Address - Fax:605-692-3951
Practice Address - Street 1:2311 YORKSHIRE DR
Practice Address - Street 2:SUITE A
Practice Address - City:BROOKINGS
Practice Address - State:SD
Practice Address - Zip Code:57006-2446
Practice Address - Country:US
Practice Address - Phone:605-692-9463
Practice Address - Fax:605-692-3951
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-30
Last Update Date:2007-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDD0402261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental