Provider Demographics
NPI:1982750766
Name:NOEL, DENISE PATRICK (DMD)
Entity Type:Individual
Prefix:DR
First Name:DENISE
Middle Name:PATRICK
Last Name:NOEL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:618 N HOUSTON LAKE BLVD
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31028-1010
Mailing Address - Country:US
Mailing Address - Phone:478-953-6554
Mailing Address - Fax:478-953-6519
Practice Address - Street 1:618 N HOUSTON LAKE BLVD
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:GA
Practice Address - Zip Code:31028-1010
Practice Address - Country:US
Practice Address - Phone:478-953-6554
Practice Address - Fax:478-953-6519
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2015-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA107041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA258250208OtherSS NUMBER
GA581904810OtherTAX ID
GA000379387BMedicaid