Provider Demographics
NPI:1356508758
Name:MICHAEL W. NOBLE, DMD, PC
Entity type:Organization
Organization Name:MICHAEL W. NOBLE, DMD, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CMPE
Authorized Official - Phone:314-251-6725
Mailing Address - Street 1:60 EAST NORTH STREET
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:MO
Mailing Address - Zip Code:63025
Mailing Address - Country:US
Mailing Address - Phone:314-251-6725
Mailing Address - Fax:314-251-6726
Practice Address - Street 1:60 EAST NORTH STREET
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:MO
Practice Address - Zip Code:63025
Practice Address - Country:US
Practice Address - Phone:314-251-6725
Practice Address - Fax:314-251-6726
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MICHAEL W. NOBLE, DMD, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-05-22
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1083817142OtherNPI NUMBER FOR MAKEPEACE B. CHARLES, DDS
MO1760558787OtherNPI NUMBER FOR MICHAEL E. SUDEN, DDS