Provider Demographics
NPI:1114935335
Name:NOBLITT, ALLYN RAY (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALLYN
Middle Name:RAY
Last Name:NOBLITT
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 1:102 FLAG LAKE DR STE B
Mailing Address - Street 2:
Mailing Address - City:LAKE JACKSON
Mailing Address - State:TX
Mailing Address - Zip Code:77566-6215
Mailing Address - Country:US
Mailing Address - Phone:979-297-6612
Mailing Address - Fax:979-297-1059
Practice Address - Street 1:102 FLAG LAKE DR STE B
Practice Address - Street 2:
Practice Address - City:LAKE JACKSON
Practice Address - State:TX
Practice Address - Zip Code:77566-6215
Practice Address - Country:US
Practice Address - Phone:979-297-6612
Practice Address - Fax:979-297-1059
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2024-02-23
Deactivation Date:2024-02-15
Deactivation Code:
Reactivation Date:2024-02-23
Provider Licenses
StateLicense IDTaxonomies
TX13007122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist