Provider Demographics
NPI:1134107485
Name:ROOT, NOEL (DDS)
Entity Type:Individual
Prefix:
First Name:NOEL
Middle Name:
Last Name:ROOT
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:PO BOX 9
Mailing Address - Street 2:
Mailing Address - City:FRANKTOWN
Mailing Address - State:VA
Mailing Address - Zip Code:23354-0009
Mailing Address - Country:US
Mailing Address - Phone:757-442-4819
Mailing Address - Fax:757-442-9505
Practice Address - Street 1:9159 FRANKTOWN ROAD
Practice Address - Street 2:
Practice Address - City:FRANKTOWN
Practice Address - State:VA
Practice Address - Zip Code:23354
Practice Address - Country:US
Practice Address - Phone:757-442-4819
Practice Address - Fax:757-442-9505
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401005988122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
V00569Medicare UPIN