Provider Demographics
NPI:1275671109
Name:MICHAEL W. NOBLE DMD PC
Entity Type:Organization
Organization Name:MICHAEL W. NOBLE DMD PC
Other - Org Name:ORAL FACIAL SURGERY INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:V
Authorized Official - Last Name:SARLI
Authorized Official - Suffix:
Authorized Official - Credentials:MHA
Authorized Official - Phone:314-251-6725
Mailing Address - Street 1:1585 WOODLAKE DR
Mailing Address - Street 2:SUITE 208
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-5740
Mailing Address - Country:US
Mailing Address - Phone:314-878-6725
Mailing Address - Fax:314-878-6726
Practice Address - Street 1:1585 WOODLAKE DR
Practice Address - Street 2:SUITE 208
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-5740
Practice Address - Country:US
Practice Address - Phone:314-251-6725
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2007-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20050128851223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1366557530OtherNPI NUMBER
MO1760558787OtherDR. SUDEN'S NPI#