Healthcare Provider Details

I. General information

NPI: 1255125969
Provider Name (Legal Business Name): NOAH ROBERT CARILLON DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2025
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 ARCH ST STE 303
AKRON OH
44304-1432
US

IV. Provider business mailing address

75 ARCH ST STE 303
AKRON OH
44304-1432
US

V. Phone/Fax

Practice location:
  • Phone: 330-375-6262
  • Fax:
Mailing address:
  • Phone: 330-375-6262
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number30.028374
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: