Provider Demographics
NPI:1245760008
Name:JKL DENTAL
Entity Type:Organization
Organization Name:JKL DENTAL
Other - Org Name:NOBLE SMILES DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JONG-RAYE
Authorized Official - Middle Name:
Authorized Official - Last Name:LIANG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:734-657-3948
Mailing Address - Street 1:2597 MILLGATE CT
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46033-2207
Mailing Address - Country:US
Mailing Address - Phone:734-657-3948
Mailing Address - Fax:
Practice Address - Street 1:9779 E 146TH ST STE 100
Practice Address - Street 2:
Practice Address - City:NOBLESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46060-4327
Practice Address - Country:US
Practice Address - Phone:317-219-3099
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-14
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental