Provider Demographics
NPI:1295382992
Name:NOBLE ORTHODONTICS, LLC
Entity Type:Organization
Organization Name:NOBLE ORTHODONTICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LLC MEMBERS
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:LABLONDE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MSD MS
Authorized Official - Phone:317-965-0810
Mailing Address - Street 1:109 N DODGE ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:WI
Mailing Address - Zip Code:53105-1918
Mailing Address - Country:US
Mailing Address - Phone:262-342-6496
Mailing Address - Fax:
Practice Address - Street 1:109 N DODGE ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:WI
Practice Address - Zip Code:53105-1918
Practice Address - Country:US
Practice Address - Phone:262-342-6496
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-19
Last Update Date:2019-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty