Healthcare Provider Details

I. General information

NPI: 1528086188
Provider Name (Legal Business Name): JOHN DAVID NOYES JR. DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 07/29/2020
Certification Date: 07/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 98TH ST NW STE C3
ALBUQUERQUE NM
87121-9021
US

IV. Provider business mailing address

120 98TH ST NW STE C3
ALBUQUERQUE NM
87121-9021
US

V. Phone/Fax

Practice location:
  • Phone: 510-701-5076
  • Fax:
Mailing address:
  • Phone: 505-352-5439
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDD2523
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: