Provider Demographics
NPI:1083003149
Name:NOLL, DANIEL ALAN (DMD, MSD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:ALAN
Last Name:NOLL
Suffix:
Gender:M
Credentials:DMD, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4845 RIALTO RD
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45069-2910
Mailing Address - Country:US
Mailing Address - Phone:513-772-6500
Mailing Address - Fax:
Practice Address - Street 1:7559A MALL RD
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-1401
Practice Address - Country:US
Practice Address - Phone:513-772-6500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-13
Last Update Date:2016-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04420002171223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics