Provider Demographics
NPI:1194997775
Name:NOEL K. TOLER,JR.,D.D.S.,P.A.
Entity type:Organization
Organization Name:NOEL K. TOLER,JR.,D.D.S.,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NOEL
Authorized Official - Middle Name:KENNEDY
Authorized Official - Last Name:TOLER
Authorized Official - Suffix:III
Authorized Official - Credentials:DMD
Authorized Official - Phone:601-981-3020
Mailing Address - Street 1:2600 RIVER RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-5013
Mailing Address - Country:US
Mailing Address - Phone:601-981-3020
Mailing Address - Fax:
Practice Address - Street 1:2600 RIVER RIDGE DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-5013
Practice Address - Country:US
Practice Address - Phone:601-981-3020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-24
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2435-88261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental