Healthcare Provider Details

I. General information

NPI: 1477536357
Provider Name (Legal Business Name): KEVIN M NOALL DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/23/2005
Last Update Date: 09/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

521 N 11TH ST
RICHMOND VA
23298-5045
US

IV. Provider business mailing address

1200 SEMMES AVE
RICHMOND VA
23224-2178
US

V. Phone/Fax

Practice location:
  • Phone: 804-828-2522
  • Fax:
Mailing address:
  • Phone: 804-828-2522
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number0401414151
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: