MEDICARE: DR. PAUL NOLAN CARDON D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	6400	CO

General Provider Information

NPI Number	:	1083618342
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAUL NOLAN CARDON D.D.S.

Provider Business Mailing Address
First Line	:	757W STADIUM BLVD B
Second Line	:
City	:	JEFFERSON CITY
State	:	MO
Zip	:	65109-4786
Country	:	US
Telephone Number	:	573-636-5522
Fax Number	:	573-636-3328

Provider Business Practice Location Address
First Line	:	325 2ND ST
Second Line	:
City	:	MONUMENT
State	:	CO
Zip	:	80132-7935
Country	:	US
Telephone Number	:	719-481-4949
Fax Number	:	719-481-4989

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/02/2005
Last Update Date	:	11/13/2015

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