Healthcare Provider Details

I. General information

NPI: 1356508758
Provider Name (Legal Business Name): MICHAEL W. NOBLE, DMD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2008
Last Update Date: 05/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 EAST NORTH STREET
EUREKA MO
63025
US

IV. Provider business mailing address

60 EAST NORTH STREET
EUREKA MO
63025
US

V. Phone/Fax

Practice location:
  • Phone: 314-251-6725
  • Fax: 314-251-6726
Mailing address:
  • Phone: 314-251-6725
  • Fax: 314-251-6726

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number StateMO

VIII. Authorized Official

Name: MR. SCOTT EDWARD GRAHAM
Title or Position: ADMINISTRATOR
Credential: MA, CMPE
Phone: 314-251-6725