Provider Demographics
NPI:1073976585
Name:DAVID ANTHONY NOLES FAMILY DENTAL, LLC
Entity Type:Organization
Organization Name:DAVID ANTHONY NOLES FAMILY DENTAL, LLC
Other - Org Name:NOLES FAMILY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DENTIST/SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:NOLES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:812-663-7515
Mailing Address - Street 1:1315 W WESTRIDGE PKWY
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47240-3251
Mailing Address - Country:US
Mailing Address - Phone:812-663-7515
Mailing Address - Fax:812-663-3518
Practice Address - Street 1:1315 W WESTRIDGE PKWY
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:IN
Practice Address - Zip Code:47240-3251
Practice Address - Country:US
Practice Address - Phone:812-663-7515
Practice Address - Fax:812-663-3518
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-01
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12012284A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty