Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 42203 | CA |
NPI | 1013016492 |
---|---|
Provider Name | Dr. John Sloane Noe |
First Address | Walnut Grove, CA 95690-1049 |
Second Address | Walnut Grove, CA 95690 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2006 |
Last Update Date | 04/08/2008 |