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General NPI Number Information
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NPI Number | 1730635772
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Entity Type | Organization
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Legal Business Name | NOBLE DENTAL CENTER , LTD
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Dates
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Enumeration Date | 08/30/2016
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Last Update Date | 08/30/2016
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Provider Practice Location Address
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Address Line | 6235 S KEDZIE AVE
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City | CHICAGO
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State | IL
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Zip | 60629-3304
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Country | US
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Telephone | 773-776-7700
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Fax | 773-776-8244
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Provider Business Mailing Address
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Address Line | 6235 S KEDZIE AVE
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City | CHICAGO
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State | IL
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Zip | 60629-3304
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Country | US
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Telephone | 773-776-7700
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Fax | 773-776-8244
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Authorized Official
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Title or Position | DENTIST
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Name | MANHEIR F CHEHAIBER
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Credential | D.D.S
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Telephone | 773-776-7700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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