Provider Demographics
NPI:1114136165
Name:NOBLE, CASEY LYN (DDS)
Entity Type:Individual
Prefix:DR
First Name:CASEY
Middle Name:LYN
Last Name:NOBLE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1633 CHURCH ST STE 200
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-2947
Mailing Address - Country:US
Mailing Address - Phone:615-320-3636
Mailing Address - Fax:615-320-9114
Practice Address - Street 1:1633 CHURCH ST STE 200
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-2947
Practice Address - Country:US
Practice Address - Phone:615-320-3636
Practice Address - Fax:615-320-9114
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2009-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL54291223G0001X
KS605011223E0200X
TN89231223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No1223G0001XDental ProvidersDentistGeneral Practice