Provider Demographics
NPI:1649320268
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:MICHAEL
Authorized Official - Middle Name:V
Authorized Official - Last Name:SARLI
Authorized Official - Suffix:
Authorized Official - Credentials:MHA
Authorized Official - Phone:314-251-6725
Mailing Address - Street 1:621 SOUTH NEW BALLAS ROAD
Mailing Address - Street 2:SUITE 16A
Mailing Address - City:ST. LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141
Mailing Address - Country:US
Mailing Address - Phone:314-251-6725
Mailing Address - Fax:314-251-4367
Practice Address - Street 1:621 S NEW BALLAS RD
Practice Address - Street 2:SUITE 16A
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8232
Practice Address - Country:US
Practice Address - Phone:314-251-6725
Practice Address - Fax:314-251-4367
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2007-08-01
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
MO1083817142OtherDR. CHARLES' NPI#
MO1316937634OtherNPI NUMBER
MO1366557530OtherNPI NUMBER
MO1356331672OtherNPI NUMBER
MO1740270065OtherNPI NUMBER