Basic Information
Provider Information
NPI: 1538354469
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BIXEL
FirstName: NOEL
MiddleName: LEE
NamePrefix: DR.
NameSuffix:  
Credential: D.D.S.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 737 W CHILDS AVE
Address2:  
City: MERCED
State: CA
PostalCode: 953416805
CountryCode: US
TelephoneNumber: 2093855481
FaxNumber: 2093831296
Practice Location
Address1: 13161 JEFFERSON ST
Address2:  
City: LE GRAND
State: CA
PostalCode: 953339766
CountryCode: US
TelephoneNumber: 2093891900
FaxNumber: 2093891907
Other Information
ProviderEnumerationDate: 09/13/2007
LastUpdateDate: 12/02/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
1223G0001X17878CAY Dental ProvidersDentistGeneral Practice

No ID Information.


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