Individual provider Active NPI

Tim C Knecht, DMD

  • Dentist
  • Bowling Green, KY
National Provider Identifier
1396846747
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
6420 Issued in KY
Practice address
727 31W Bypass
Suite 103
Bowling Green, KY 42101
Phone
(270) 842-4558
Fax
(270) 842-7083
NPI assigned
Sep 26, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 6420 KY Primary

Addresses

Primary practice location

727 31W Bypass
Suite 103
Bowling Green, KY 42101

Mailing address

727 31W Bypass
Suite 103
Bowling Green, KY 42101
Phone (270) 842-4558

Other identifiers 1

IdentifierTypeStateIssuer
60064201MedicaidKY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY
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

Enrollment IDStateProvider typePAC IDDetails
I20160511001629 KY Order and Referring Only - DentistPractitioner - Dentist 0446549661

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
6420KYMDDentist

NPI Registry JSON

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

{
    "created_epoch": "1159228800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1396846747",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "727 31W BYPASS",
            "address_2": "SUITE 103",
            "city": "BOWLING GREEN",
            "state": "KY",
            "postal_code": "42101",
            "telephone_number": "270-842-4558",
            "fax_number": "270-842-7083"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "727 31W BYPASS",
            "address_2": "SUITE 103",
            "city": "BOWLING GREEN",
            "state": "KY",
            "postal_code": "42101",
            "telephone_number": "270-842-4558",
            "fax_number": "270-842-7083"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KNECHT",
        "first_name": "TIM",
        "middle_name": "C",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-26",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "KY",
            "license": "6420",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "60064201",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bowling Green, KY

Sources for this page

Verify at the official NPI Registry.