Healthcare Provider Details

I. General information

NPI: 1700644788
Provider Name (Legal Business Name): DR. NOAH NUGENT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2024
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14275 PIPELINE AVE
CHINO CA
91710-5639
US

IV. Provider business mailing address

14275 PIPELINE AVE
CHINO CA
91710-5639
US

V. Phone/Fax

Practice location:
  • Phone: 909-613-1144
  • Fax:
Mailing address:
  • Phone: 909-613-1144
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number112688
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDDS112688
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: