Provider Demographics
NPI:1063693315
Name:NOAKES, EDWARD BRUCE III (DMD, MS)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:BRUCE
Last Name:NOAKES
Suffix:III
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2835 MCFARLAND RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107
Mailing Address - Country:US
Mailing Address - Phone:815-636-1600
Mailing Address - Fax:
Practice Address - Street 1:2835 MCFARLAND RD
Practice Address - Street 2:SUITE B
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-6819
Practice Address - Country:US
Practice Address - Phone:815-636-1600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-15
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6091-15122300000X
IL021.0020681223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No122300000XDental ProvidersDentist