Healthcare Provider Details

I. General information

NPI: 1649320268
Provider Name (Legal Business Name): MICHAEL W NOBLE DMD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 08/01/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 S NEW BALLAS RD SUITE 16A
SAINT LOUIS MO
63141-8232
US

IV. Provider business mailing address

621 SOUTH NEW BALLAS ROAD SUITE 16A
ST. LOUIS MO
63141
US

V. Phone/Fax

Practice location:
  • Phone: 314-251-6725
  • Fax: 314-251-4367
Mailing address:
  • Phone: 314-251-6725
  • Fax: 314-251-4367

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. MICHAEL V SARLI
Title or Position: ADMINISTRATOR
Credential: MHA
Phone: 314-251-6725