Provider Demographics
NPI:1700879095
Name:NOONAN, CHRISTOPHER E (DMD MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:E
Last Name:NOONAN
Suffix:
Gender:M
Credentials:DMD MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2800 CANNONS LN
Mailing Address - Street 2:STE 100
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40205
Mailing Address - Country:US
Mailing Address - Phone:502-454-4885
Mailing Address - Fax:502-452-1926
Practice Address - Street 1:225 ABRAHAM FLEXNER WAY
Practice Address - Street 2:STE 302
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1882
Practice Address - Country:US
Practice Address - Phone:502-587-7874
Practice Address - Fax:502-587-0758
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2017-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYMD-39508204E00000X
KY74861223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200521540Medicaid
KY60003274Medicaid
KY000000364871OtherBCBS
KY64098635Medicaid
I33115Medicare UPIN
IN200521540Medicaid