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General NPI Number Information
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NPI Number | 1588097885
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Entity Type | Organization
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Legal Business Name | NOBLE DENTAL PLLC
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Dates
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Enumeration Date | 08/10/2013
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Last Update Date | 08/10/2013
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Provider Practice Location Address
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Address Line | 2016 W SUPERIOR ST
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City | DULUTH
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State | MN
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Zip | 55806-3524
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Country | US
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Telephone | 218-722-2575
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Fax |
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Provider Business Mailing Address
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Address Line | 2016 W SUPERIOR ST
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City | DULUTH
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State | MN
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Zip | 55806-3524
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Country | US
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Telephone | 218-722-2575
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | DR. JACOB D. NOBLE
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Credential | DDS
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Telephone | 218-722-2575
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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 | D13068
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License Number State | MN
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