Provider Demographics
NPI:1083058549
Name:NOBLE DENTAL CLINIC
Entity Type:Organization
Organization Name:NOBLE DENTAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR
Authorized Official - Prefix:DR
Authorized Official - First Name:SARI
Authorized Official - Middle Name:
Authorized Official - Last Name:ALQSOUS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:216-268-3060
Mailing Address - Street 1:2140 NOBLE RD
Mailing Address - Street 2:
Mailing Address - City:EAST CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44112-1736
Mailing Address - Country:US
Mailing Address - Phone:216-268-5553
Mailing Address - Fax:
Practice Address - Street 1:2140 NOBLE RD
Practice Address - Street 2:
Practice Address - City:EAST CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44112-1736
Practice Address - Country:US
Practice Address - Phone:216-268-3060
Practice Address - Fax:216-269-5553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-26
Last Update Date:2013-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-0233051223G0001X
OH30-0231341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty