Healthcare Provider Details

I. General information

NPI: 1912708462
Provider Name (Legal Business Name): NOBLE DAVIS ANDERSON DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2025
Last Update Date: 03/21/2025
Certification Date: 03/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

136 TIMBER RD
LEBANON PA
17042-8920
US

IV. Provider business mailing address

136 TIMBER RD
LEBANON PA
17042-8920
US

V. Phone/Fax

Practice location:
  • Phone: 717-269-3347
  • Fax:
Mailing address:
  • Phone: 717-269-3347
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDS0204668L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: