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General NPI Number Information
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NPI Number | 1649320268
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Entity Type | Organization
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Legal Business Name | MICHAEL W NOBLE DMD PC
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Dates
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Enumeration Date | 01/12/2007
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Last Update Date | 08/01/2007
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Provider Practice Location Address
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Address Line | 621 S NEW BALLAS RD SUITE 16A
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City | SAINT LOUIS
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State | MO
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Zip | 63141-8232
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Country | US
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Telephone | 314-251-6725
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Fax | 314-251-4367
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Provider Business Mailing Address
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Address Line | 621 SOUTH NEW BALLAS ROAD SUITE 16A
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City | ST. LOUIS
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State | MO
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Zip | 63141
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Country | US
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Telephone | 314-251-6725
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Fax | 314-251-4367
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. MICHAEL V SARLI
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Credential | MHA
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Telephone | 314-251-6725
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number |
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License Number State | MO
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