Provider Demographics
NPI:1982916193
Name:JAKE ROBERT NOEL D.M.D. P.C.
Entity type:Organization
Organization Name:JAKE ROBERT NOEL D.M.D. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:E
Authorized Official - Last Name:PULLEN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:256-533-3735
Mailing Address - Street 1:2331 PANSY ST SW
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-3804
Mailing Address - Country:US
Mailing Address - Phone:256-533-7700
Mailing Address - Fax:
Practice Address - Street 1:2331 PANSY ST SW
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-3804
Practice Address - Country:US
Practice Address - Phone:256-533-7700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-06
Last Update Date:2010-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5757 C1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty