Provider Demographics
NPI:1588683700
Name:DALLISON, NOBLE SKIDMORE (DDS)
Entity Type:Individual
Prefix:DR
First Name:NOBLE
Middle Name:SKIDMORE
Last Name:DALLISON
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 1:1 PROFESSIONAL DR
Mailing Address - Street 2:
Mailing Address - City:BELLA VISTA
Mailing Address - State:AR
Mailing Address - Zip Code:72714-2462
Mailing Address - Country:US
Mailing Address - Phone:479-855-9554
Mailing Address - Fax:
Practice Address - Street 1:1 PROFESSIONAL DR
Practice Address - Street 2:
Practice Address - City:BELLA VISTA
Practice Address - State:AR
Practice Address - Zip Code:72714-2462
Practice Address - Country:US
Practice Address - Phone:479-855-9554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR22491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice