Provider Demographics
NPI:1568281889
Name:NOONAN, KATJA H (DDS)
Entity type:Individual
Prefix:DR
First Name:KATJA
Middle Name:H
Last Name:NOONAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1202 OPAL ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92109-1832
Mailing Address - Country:US
Mailing Address - Phone:858-900-6571
Mailing Address - Fax:
Practice Address - Street 1:4776 CASS ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92109-2603
Practice Address - Country:US
Practice Address - Phone:858-270-1922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-03
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1108791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice