Provider Demographics
NPI:1346752011
Name:NOBLESVILLE DENTAL ASSOCIATES LLC
Entity type:Organization
Organization Name:NOBLESVILLE DENTAL ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:T
Authorized Official - Last Name:KINNEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:317-575-1120
Mailing Address - Street 1:17567 RIVER AVE.
Mailing Address - Street 2:
Mailing Address - City:NOBLESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46062
Mailing Address - Country:US
Mailing Address - Phone:317-773-2983
Mailing Address - Fax:317-773-2762
Practice Address - Street 1:17567 RIVER AVE.
Practice Address - Street 2:
Practice Address - City:NOBLESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46062
Practice Address - Country:US
Practice Address - Phone:317-773-2983
Practice Address - Fax:317-773-2762
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NOBLESVILLE DENTAL ASSOCIATES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-11-02
Last Update Date:2017-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12008106A122300000X
IN12012314A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty