Provider Demographics
NPI:1144375387
Name:NOBLES, MONICA S (DDS)
Entity type:Individual
Prefix:DR
First Name:MONICA
Middle Name:S
Last Name:NOBLES
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:PO BOX 24268
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76124-1268
Mailing Address - Country:US
Mailing Address - Phone:817-734-8666
Mailing Address - Fax:
Practice Address - Street 1:1801 EASTCHASE PKWY
Practice Address - Street 2:SUITE 119
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76120-4424
Practice Address - Country:US
Practice Address - Phone:817-734-8666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2014-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX224751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX178313602Medicaid
TX178313601Medicaid