1649320268 NPI number — MICHAEL W NOBLE DMD PC

Table of content: (NPI 1649320268)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649320268 NPI number — MICHAEL W NOBLE DMD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MICHAEL W NOBLE DMD PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1649320268
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/01/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
621 SOUTH NEW BALLAS ROAD
Provider Second Line Business Mailing Address:
SUITE 16A
Provider Business Mailing Address City Name:
ST. LOUIS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63141
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-251-6725
Provider Business Mailing Address Fax Number:
314-251-4367

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
621 S NEW BALLAS RD
Provider Second Line Business Practice Location Address:
SUITE 16A
Provider Business Practice Location Address City Name:
SAINT LOUIS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63141-8232
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-251-6725
Provider Business Practice Location Address Fax Number:
314-251-4367
Provider Enumeration Date:
01/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SARLI
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
V
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
314-251-6725

Provider Taxonomy Codes

  • Taxonomy code: 1223S0112X , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1083817142 . This is a "DR. CHARLES' NPI#" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 1316937634 . This is a "NPI NUMBER" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 1366557530 . This is a "NPI NUMBER" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 1356331672 . This is a "NPI NUMBER" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 1740270065 . This is a "NPI NUMBER" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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