Healthcare Provider Details

I. General information

NPI: 1295382992
Provider Name (Legal Business Name): NOBLE ORTHODONTICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2019
Last Update Date: 08/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 N DODGE ST
BURLINGTON WI
53105-1918
US

IV. Provider business mailing address

109 N DODGE ST
BURLINGTON WI
53105-1918
US

V. Phone/Fax

Practice location:
  • Phone: 262-342-6496
  • Fax:
Mailing address:
  • Phone: 262-342-6496
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: BRIAN PATRICK LABLONDE
Title or Position: LLC MEMBERS
Credential: DDS MSD MS
Phone: 317-965-0810