MEDICARE: NOBLE CREEK FAMILY DENITSTRY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	12010876A	IN

General Provider Information

NPI Number	:	1053688986
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NOBLE CREEK FAMILY DENITSTRY LLC

Provider Business Mailing Address
First Line	:	485 NOBLE CREEK DR
Second Line	:
City	:	NOBLESVILLE
State	:	IN
Zip	:	46060-3108
Country	:	US
Telephone Number	:	317-770-1247
Fax Number	:	317-770-7018

Provider Business Practice Location Address
First Line	:	485 NOBLE CREEK DR
Second Line	:
City	:	NOBLESVILLE
State	:	IN
Zip	:	46060-3108
Country	:	US
Telephone Number	:	317-770-1247
Fax Number	:	317-770-7018

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JAMES A HUSEMAN
Credential	:	DDS
Telephone Number	:	317-770-1247

Provider Enumeration Date	:	11/21/2011
Last Update Date	:	11/21/2011

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