Basic Information
| Provider Information | |||||||||
| NPI: | 1952718405 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KNECHTEL | ||||||||
| FirstName: | CHARLES | ||||||||
| MiddleName: | DANIEL | ||||||||
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| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6950 NE CAMPUS WAY | ||||||||
| Address2: | |||||||||
| City: | HILLSBORO | ||||||||
| State: | OR | ||||||||
| PostalCode: | 971245611 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5039522125 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2365 NW STEWART PKWY | ||||||||
| Address2: | |||||||||
| City: | ROSEBURG | ||||||||
| State: | OR | ||||||||
| PostalCode: | 974715653 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5039522125 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/16/2014 | ||||||||
| LastUpdateDate: | 11/18/2015 | ||||||||
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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 | 122300000X | DE60501263 | WA | N | Dental Providers | Dentist | 122300000X | D10374 | OR | Y | Dental Providers | Dentist |
No ID Information.