Healthcare Provider Details

I. General information

NPI: 1982750766
Provider Name (Legal Business Name): DENISE PATRICK NOEL DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 12/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

618 N HOUSTON LAKE BLVD
CENTERVILLE GA
31028-1010
US

IV. Provider business mailing address

618 N HOUSTON LAKE BLVD
CENTERVILLE GA
31028-1010
US

V. Phone/Fax

Practice location:
  • Phone: 478-953-6554
  • Fax: 478-953-6519
Mailing address:
  • Phone: 478-953-6554
  • Fax: 478-953-6519

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number10704
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: