Provider Demographics
NPI:1134334428
Name:DEREK R. NOONAN, DMD, LLC
Entity type:Organization
Organization Name:DEREK R. NOONAN, DMD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:NOONAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:973-729-3222
Mailing Address - Street 1:270 SPARTA AVE
Mailing Address - Street 2:SUITE 209
Mailing Address - City:SPARTA
Mailing Address - State:NJ
Mailing Address - Zip Code:07871-1122
Mailing Address - Country:US
Mailing Address - Phone:973-729-3222
Mailing Address - Fax:973-729-6143
Practice Address - Street 1:270 SPARTA AVE
Practice Address - Street 2:SUITE 209
Practice Address - City:SPARTA
Practice Address - State:NJ
Practice Address - Zip Code:07871-1122
Practice Address - Country:US
Practice Address - Phone:973-729-3222
Practice Address - Fax:973-729-6143
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ215551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty