Provider Demographics
NPI:1770694432
Name:LIONEL W. NOONAN, JR. DMD, PC
Entity type:Organization
Organization Name:LIONEL W. NOONAN, JR. DMD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATION PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LIONEL
Authorized Official - Middle Name:WINSTON
Authorized Official - Last Name:NOONAN
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMD
Authorized Official - Phone:251-626-2141
Mailing Address - Street 1:27985 US HIGHWAY 98
Mailing Address - Street 2:
Mailing Address - City:DAPHNE
Mailing Address - State:AL
Mailing Address - Zip Code:36526-4722
Mailing Address - Country:US
Mailing Address - Phone:251-626-2141
Mailing Address - Fax:251-626-7011
Practice Address - Street 1:27985 US HIGHWAY 98
Practice Address - Street 2:
Practice Address - City:DAPHNE
Practice Address - State:AL
Practice Address - Zip Code:36526-4722
Practice Address - Country:US
Practice Address - Phone:251-626-2141
Practice Address - Fax:251-626-7011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALLNO 4656261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental