Provider Demographics
NPI:1083759070
Name:G THOMAS NOAKES DDS
Entity Type:Organization
Organization Name:G THOMAS NOAKES DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:GORDON
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:NOAKES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:330-856-5581
Mailing Address - Street 1:1121 NILES CORTLAND RD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44484
Mailing Address - Country:US
Mailing Address - Phone:330-856-5581
Mailing Address - Fax:330-856-5894
Practice Address - Street 1:1121 NILES CORTLAND RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44484
Practice Address - Country:US
Practice Address - Phone:330-856-5581
Practice Address - Fax:330-856-5894
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30020366122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0232117Medicaid