MEDICARE: NOBLE DENTAL CENTER , LTD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist

General Provider Information

NPI Number	:	1730635772
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NOBLE DENTAL CENTER , LTD

Provider Business Mailing Address
First Line	:	6235 S KEDZIE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60629-3304
Country	:	US
Telephone Number	:	773-776-7700
Fax Number	:	773-776-8244

Provider Business Practice Location Address
First Line	:	6235 S KEDZIE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60629-3304
Country	:	US
Telephone Number	:	773-776-7700
Fax Number	:	773-776-8244

Authorized Official
Title or Position	:	DENTIST
Name	:	MANHEIR F CHEHAIBER
Credential	:	D.D.S
Telephone Number	:	773-776-7700

Provider Enumeration Date	:	08/30/2016
Last Update Date	:	08/30/2016

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Directions to “NOBLE DENTAL CENTER , LTD ” Practice Location

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