Provider Demographics
NPI:1922232438
Name:TOLER, NOEL K III (DMD)
Entity Type:Individual
Prefix:DR
First Name:NOEL
Middle Name:K
Last Name:TOLER
Suffix:III
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 RIVER RIDGE ROAD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216
Mailing Address - Country:US
Mailing Address - Phone:601-981-3020
Mailing Address - Fax:
Practice Address - Street 1:2600 RIVER RIDGE ROAD
Practice Address - Street 2:SUITE 104
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216
Practice Address - Country:US
Practice Address - Phone:601-981-3020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-12
Last Update Date:2009-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2435-881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice