MEDICARE: NOOR AL SHALTONI DDS

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	1223P0221X	Pediatric Dentistry	DF100044	MA
2	390200000X	Student in an Organized Health Care Education/Training Program
3	1223P0221X	Pediatric Dentistry	12014657A	IN

General Provider Information

NPI Number	:	1912631938
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NOOR AL SHALTONI DDS

Provider Business Mailing Address
First Line	:	2101 SPOONBILL DR
Second Line	:
City	:	WEST LAFAYETTE
State	:	IN
Zip	:	47906-6704
Country	:	US
Telephone Number	:	832-621-1998
Fax Number	:

Provider Business Practice Location Address
First Line	:	13760 LAKERIDGE DR
Second Line	:
City	:	FISHERS
State	:	IN
Zip	:	46037-7608
Country	:	US
Telephone Number	:	317-588-2575
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/14/2022
Last Update Date	:	12/24/2025

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Directions to “ NOOR AL SHALTONI DDS” Practice Location

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