Active NPI
Luke Noble, DDS
- Endodontics
- Gresham, OR
National Provider Identifier
1962899286
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Endodontics
- License
- D11613
- Practice address
- 320 NE 5TH St
Gresham, OR 97030 - Phone
- (503) 665-0495
- NPI assigned
- Apr 24, 2015
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 1001093-15 | WI | |
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Endodontics | 1223E0200X | D11613 | OR | Primary |
Addresses
Primary practice location
320 NE 5TH St
Gresham, OR 97030
Mailing address
320 NE 5TH St
Gresham, OR 97030-7308
Phone (503) 665-0495
Other practice location 1
49 Diane Ln
Appleton, WI 54915-7203
Phone (920) 809-0485
Other practice location 2
RAF Lakenheath 48 MDG/SGHC
Unit 5115
Apo, AE 09461-5115
Phone (314) 226-8889
Other practice location 3
1120 15th St # Gc5110
Augusta, GA 30912-0004
Phone (706) 721-2251
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20251022003958 | WA | Order and Referring Only - Dentist | 2769970664 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1001093-15 | WI | MD | Dentist |
| D11613 | OR | MD | Endodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1429833600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1675209600000",
"number": "1962899286",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "320 NE 5TH ST",
"city": "GRESHAM",
"state": "OR",
"postal_code": "970307308",
"telephone_number": "503-665-0495"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "320 NE 5TH ST",
"city": "GRESHAM",
"state": "OR",
"postal_code": "97030",
"telephone_number": "503-665-0495"
}
],
"practiceLocations": [
{
"address_1": "49 Diane Ln",
"address_purpose": "LOCATION",
"city": "Appleton",
"state": "WI",
"postal_code": "549157203",
"country_code": "US",
"telephone_number": "920-809-0485",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "RAF Lakenheath 48 MDG/SGHC",
"address_2": "Unit 5115",
"address_purpose": "LOCATION",
"city": "APO",
"state": "AE",
"postal_code": "094615115",
"country_code": "US",
"telephone_number": "314-226-8889",
"country_name": "United States",
"address_type": "MIL"
},
{
"address_1": "1120 15th St # Gc5110",
"address_purpose": "LOCATION",
"city": "Augusta",
"state": "GA",
"postal_code": "309120004",
"country_code": "US",
"telephone_number": "706-721-2251",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "NOBLE",
"first_name": "LUKE",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2015-04-24",
"last_updated": "2023-02-01",
"certification_date": "2023-02-01",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "WI",
"license": "1001093-15",
"primary": false
},
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "1223E0200X",
"taxonomy_group": "",
"desc": "Dentist, Endodontics",
"state": "OR",
"license": "D11613",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Gresham, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.