Provider Demographics
NPI:1548151574
Name:POOLE, NOAH (DDS)
Entity type:Individual
Prefix:
First Name:NOAH
Middle Name:
Last Name:POOLE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2575 STEELE RD APT 218
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92408-3981
Mailing Address - Country:US
Mailing Address - Phone:321-444-8622
Mailing Address - Fax:
Practice Address - Street 1:24119 HEMLOCK AVE STE 108
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92557-7221
Practice Address - Country:US
Practice Address - Phone:951-220-6980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-09
Last Update Date:2025-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA111941122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist