Healthcare Provider Details

I. General information

NPI: 1033205992
Provider Name (Legal Business Name): DENNIS JAMES NOLAN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 SOUTH CLEVELAND AVE
MOGADORE OH
44260-1442
US

IV. Provider business mailing address

60 SOUTH CLEVELAND AVE
MOGADORE OH
44260-1442
US

V. Phone/Fax

Practice location:
  • Phone: 330-628-2424
  • Fax: 330-628-3533
Mailing address:
  • Phone: 330-628-2424
  • Fax: 330-628-3533

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number30016592
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: