Basic Information
| Provider Information | |||||||||
| NPI: | 1578638227 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KNOX | ||||||||
| FirstName: | BLAINE | ||||||||
| MiddleName: | LEROY | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3705 WARNER PARK CIR | ||||||||
| Address2: | |||||||||
| City: | MANHATTAN | ||||||||
| State: | KS | ||||||||
| PostalCode: | 665033108 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7852394174 | ||||||||
| FaxNumber: | 7852397245 | ||||||||
| Practice Location | |||||||||
| Address1: | 600 CAISSON HILL ROAD | ||||||||
| Address2: | |||||||||
| City: | FT. RILEY | ||||||||
| State: | KS | ||||||||
| PostalCode: | 664425043 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7852397241 | ||||||||
| FaxNumber: | 7852397245 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/21/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | DN 10550 | FL | X | Dental Providers | Dentist | General Practice | 1223G0001X | 0401006441 | VA | X | Dental Providers | Dentist | General Practice |
No ID Information.