Jeffrey Owen Knutzen, D.D.S., P.C.

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

014997 Issued in MO

Legal business name

JEFFREY OWEN KNUTZEN, D.D.S., P.C.

Practice address

1819 W 32ND St
Joplin, MO 64804-1528

Phone

(417) 623-6202

Fax

(417) 624-4521

NPI assigned

Jun 11, 2009

Organization subpart

No

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

Authorized official

Name

Mrs. Lisa S. Knutzen

Title

Vice President

Phone

(417) 623-6202

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

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

{
    "created_epoch": "1244678400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1244678400000",
    "number": "1669609137",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1819 W 32ND ST",
            "city": "JOPLIN",
            "state": "MO",
            "postal_code": "648041528",
            "telephone_number": "417-623-6202",
            "fax_number": "417-624-4521"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1819 W 32ND ST",
            "city": "JOPLIN",
            "state": "MO",
            "postal_code": "648041528",
            "telephone_number": "417-623-6202",
            "fax_number": "417-624-4521"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEFFREY OWEN KNUTZEN, D.D.S., P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-06-11",
        "last_updated": "2009-06-11",
        "status": "A",
        "authorized_official_last_name": "KNUTZEN",
        "authorized_official_first_name": "LISA",
        "authorized_official_middle_name": "S.",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "417-623-6202",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "MO",
            "license": "014997",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4054863801",
            "state": "KS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "402752018",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Yaso M Jayawardhana, NP
• Connor Jeffers
• Tyleigh Jeffers
• Jeffery CM Johnson DC LLC
• Jeffrey D. Coleman, O.D., LLC
• David Benjamin Jeffs, DO
• Carrie J Jenkins, MSN, APRN, FNP-BC
• Meredith Joann Jenkins, PA-C
• Robyn Lynn Jennings, COTA
• Hyeon Jeong

• Pediatric Dentistry in Joplin, MO
• Providers in Joplin, MO by specialty
• Pediatric Dentistry in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.