Provider Demographics
NPI:1982052049
Name:NOBLES, JOHNATHAN DEANDRE (DDS)
Entity Type:Individual
Prefix:
First Name:JOHNATHAN
Middle Name:DEANDRE
Last Name:NOBLES
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4145 BELT LINE RD STE 208
Mailing Address - Street 2:
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-4378
Mailing Address - Country:US
Mailing Address - Phone:972-704-1108
Mailing Address - Fax:
Practice Address - Street 1:4145 BELT LINE RD STE 208
Practice Address - Street 2:
Practice Address - City:ADDISON
Practice Address - State:TX
Practice Address - Zip Code:75001-4378
Practice Address - Country:US
Practice Address - Phone:972-704-1108
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-31
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32358122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist