Gregory Robert Knutsen, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DD4661 Issued in NM

Practice address

1001 W Broadway
Farmington, NM 87401-5638

Phone

(505) 327-4796

Fax

(505) 325-9113

NPI assigned

Jun 18, 2013

Last updated

Apr 18, 2017By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1371513600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1492473600000",
    "number": "1265871859",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1001 W. BROADWAY AVE.",
            "city": "FARMINGTON",
            "state": "NM",
            "postal_code": "874015638",
            "telephone_number": "505-327-4796",
            "fax_number": "505-325-9113"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1001 W BROADWAY",
            "city": "FARMINGTON",
            "state": "NM",
            "postal_code": "874015638",
            "telephone_number": "505-327-4796",
            "fax_number": "505-325-9113"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KNUTSEN",
        "first_name": "GREGORY",
        "middle_name": "ROBERT",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-06-18",
        "last_updated": "2017-04-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "28927",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NM",
            "license": "DD4661",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dennis R Kloberdanz, MD
• Shaylee Rose Klock, FNP-C
• Amy Joanne Knackendoffel, PA-C
• Knew Creation LLC
• Jasin E Knights, PHYSICAL THERAPIST
• John H. Koewler, PH.D.
• Jeanne Marie Kofron, LISW
• Samrat Babu Koirala, M.B.B.S
• Edward Kompare, M.D.
• Dawn J Koons, LPCC

• General Practice Dentistry in Farmington, NM
• Providers in Farmington, NM by specialty
• General Practice Dentistry in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.