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General NPI Number Information
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NPI Number | 1194997775
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Entity Type | Organization
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Legal Business Name | NOEL K. TOLER,JR.,D.D.S.,P.A.
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Dates
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Enumeration Date | 03/24/2008
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Last Update Date | 03/24/2008
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Provider Practice Location Address
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Address Line | 2600 RIVER RIDGE DR
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City | JACKSON
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State | MS
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Zip | 39216-5013
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Country | US
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Telephone | 601-981-3020
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Fax |
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Provider Business Mailing Address
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Address Line | 2600 RIVER RIDGE DR
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City | JACKSON
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State | MS
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Zip | 39216-5013
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Country | US
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Telephone | 601-981-3020
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. NOEL KENNEDY TOLER III
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Credential | D.M.D.
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Telephone | 601-981-3020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 2435-88
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License Number State | MS
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