Provider Demographics
NPI:1679340459
Name:KATHERINE A. KNABE, LLC
Entity type:Organization
Organization Name:KATHERINE A. KNABE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST/PRACTICE OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:A
Authorized Official - Last Name:KNABE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:815-494-8990
Mailing Address - Street 1:W1158 MEADOWSWEET PASS
Mailing Address - Street 2:
Mailing Address - City:IXONIA
Mailing Address - State:WI
Mailing Address - Zip Code:53036-9552
Mailing Address - Country:US
Mailing Address - Phone:815-494-8990
Mailing Address - Fax:
Practice Address - Street 1:970 S SILVER LAKE ST STE 101
Practice Address - Street 2:
Practice Address - City:OCONOMOWOC
Practice Address - State:WI
Practice Address - Zip Code:53066-3802
Practice Address - Country:US
Practice Address - Phone:815-494-8990
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-11
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental