Provider Demographics
NPI:1861536468
Name:KNOWLES, DONALD L (DDS)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:L
Last Name:KNOWLES
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 1:1235 W MARKET ST
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45805-2728
Mailing Address - Country:US
Mailing Address - Phone:419-222-1188
Mailing Address - Fax:419-228-4305
Practice Address - Street 1:1235 W MARKET ST
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45805-2728
Practice Address - Country:US
Practice Address - Phone:419-222-1188
Practice Address - Fax:419-228-4305
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH166261223P0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHKN0501362Medicare UPIN