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General NPI Number Information
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NPI Number | 1609065101
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Entity Type | Organization
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Legal Business Name | MATTHEW G. NOLL DDS PLLC
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Dates
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Enumeration Date | 10/20/2007
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Last Update Date | 10/20/2007
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Provider Practice Location Address
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Address Line | 9431 W THUNDERBIRD RD
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City | PEORIA
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State | AZ
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Zip | 85381-4237
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Country | US
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Telephone | 623-974-0321
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Fax |
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Provider Business Mailing Address
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Address Line | 9431 W THUNDERBIRD RD
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City | PEORIA
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State | AZ
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Zip | 85381-4237
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Country | US
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Telephone | 623-974-0321
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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. MATTHEW NOLL
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Credential | DDS
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Telephone | 623-974-0321
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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 | 5420
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License Number State | AZ
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