Active NPI
Walter Knysz Jr., DDS
- Dentist
- Dearborn, MI
National Provider Identifier
1003974155
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 2901011077
- Practice address
- 23401 Ford Road
Dearborn, MI 48128 - Phone
- (313) 561-3367
- NPI assigned
- Dec 4, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 2901011077 | MI | Primary |
Addresses
Primary practice location
23401 Ford Road
Dearborn, MI 48128
Mailing address
300 East Long Lake
Suite 311
Bloomfield Hills, MI 48304
Phone (248) 203-1111
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2901011077 | MI | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1165190400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1003974155",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "300 EAST LONG LAKE",
"address_2": "SUITE 311",
"city": "BLOOMFIELD HILLS",
"state": "MI",
"postal_code": "48304",
"telephone_number": "248-203-1111",
"fax_number": "248-594-5971"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "23401 FORD ROAD",
"city": "DEARBORN",
"state": "MI",
"postal_code": "48128",
"telephone_number": "313-561-3367"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KNYSZ",
"first_name": "WALTER",
"name_prefix": "Dr.",
"name_suffix": "Jr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-12-04",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MI",
"license": "2901011077",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dearborn, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.