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General NPI Number Information
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NPI Number | 1952710501
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Entity Type | Organization
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Legal Business Name | KEVIN M. NOALL LLC
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Dates
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Enumeration Date | 08/07/2014
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Last Update Date | 08/07/2014
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Provider Practice Location Address
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Address Line | 7410 HEATHERFIELD LN
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City | ALEXANDRIA
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State | VA
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Zip | 22315-5287
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Country | US
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Telephone | 703-919-2733
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Fax |
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Provider Business Mailing Address
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Address Line | 7410 HEATHERFIELD LN
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City | ALEXANDRIA
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State | VA
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Zip | 22315-5287
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Country | US
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Telephone | 703-919-2733
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. KEVIN MICHAEL NOALL
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Credential | DDS
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Telephone | 703-919-2733
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 1001366
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License Number State | DC
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