MEDICARE: NOLAN DENTAL LLC

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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1326638552
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NOLAN DENTAL LLC

Provider Business Mailing Address
First Line	:	808 AVENUE C
Second Line	:
City	:	WEST POINT
State	:	GA
Zip	:	31833-1641
Country	:	US
Telephone Number	:	706-643-7731
Fax Number	:	706-643-5668

Provider Business Practice Location Address
First Line	:	808 AVENUE C
Second Line	:
City	:	WEST POINT
State	:	GA
Zip	:	31833-1641
Country	:	US
Telephone Number	:	706-643-7731
Fax Number	:	706-643-5668

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	JESSICA L RIVERA
Credential	:
Telephone Number	:	706-643-7731

Provider Enumeration Date	:	01/21/2021
Last Update Date	:	01/21/2021

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Directions to “NOLAN DENTAL LLC ” Practice Location

Language	Start Address	Practice Location

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