Provider Demographics
NPI:1831378231
Name:KNOTT, MARK DAVID (DDS)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:DAVID
Last Name:KNOTT
Suffix:
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 1:32 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:VT
Mailing Address - Zip Code:05091-1122
Mailing Address - Country:US
Mailing Address - Phone:802-457-2922
Mailing Address - Fax:802-457-1835
Practice Address - Street 1:32 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:VT
Practice Address - Zip Code:05091-1122
Practice Address - Country:US
Practice Address - Phone:802-457-2922
Practice Address - Fax:802-457-1835
Is Sole Proprietor?:No
Enumeration Date:2007-11-01
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT016-00022461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice