Kaitlin Knutson, DDS
Individual provider Active NPI Dentist · Ellsworth, WI
NPI 1104356542 · NPPES record last updated Jun 14, 2021
Key facts
- NPI
- 1104356542
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 1001604-15 (WI)
- Practice address
- 501 Lucas LN
Ellsworth, WI 54011-2800 - Phone
- (715) 273-3700
- NPI assigned
- Jun 18, 2017
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1001604-15 | WI | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Knutson Family Dental | Current |
Accepting new patients | |
| Blue Diamond Family Dental SC | Dentist | Past |
Accepting new patients |
| Shaw Family Dental SC | Past |
Accepting new patients |
Locations
501 Lucas Ln
Ellsworth, WI 54011
Phone (715) 273-3700
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 1001604-15 | WI | Yes |
Addresses
Primary practice location
501 Lucas LN
Ellsworth, WI 54011-2800
Mailing address
PO Box 310
Ellsworth, WI 54011-0310
Phone (715) 273-3700
Other providers in Ellsworth, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 14, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.