Provider Demographics
NPI:1568546109
Name:NOBLESVILLE DENTAL CLINIC, INC.
Entity Type:Organization
Organization Name:NOBLESVILLE DENTAL CLINIC, INC.
Other - Org Name:NOBLESVILLE DENTURE CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-773-7218
Mailing Address - Street 1:10550 E 211TH ST
Mailing Address - Street 2:
Mailing Address - City:NOBLESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46062-9551
Mailing Address - Country:US
Mailing Address - Phone:317-773-7218
Mailing Address - Fax:317-773-0224
Practice Address - Street 1:356 S 16TH ST
Practice Address - Street 2:
Practice Address - City:NOBLESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46060-3022
Practice Address - Country:US
Practice Address - Phone:317-773-7218
Practice Address - Fax:317-773-0224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122400000XDental ProvidersDenturistGroup - Single Specialty