Provider Demographics
NPI:1396839528
Name:NOBLE, DAVID (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:NOBLE
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 1:1410 BROADWAY ST.
Mailing Address - Street 2:PO BOX 493
Mailing Address - City:DAKOTA CITY
Mailing Address - State:NE
Mailing Address - Zip Code:68731-0493
Mailing Address - Country:US
Mailing Address - Phone:402-987-3484
Mailing Address - Fax:
Practice Address - Street 1:1410 BROADWAY ST.
Practice Address - Street 2:
Practice Address - City:DAKOTA CITY
Practice Address - State:NE
Practice Address - Zip Code:68731-0493
Practice Address - Country:US
Practice Address - Phone:402-987-3484
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE41761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47077985800Medicaid