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General NPI Number Information
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NPI Number | 1053172106
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Entity Type | Organization
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Legal Business Name | RUSSEL R. NOLASCO DDS, INC
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Dates
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Enumeration Date | 01/17/2024
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Last Update Date | 09/30/2024
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Provider Practice Location Address
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Address Line | 1042 N MOUNTAIN AVE STE A2
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City | UPLAND
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State | CA
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Zip | 91786-3695
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Country | US
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Telephone | 909-579-0623
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Fax |
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Provider Business Mailing Address
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Address Line | 1042 N MOUNTAIN AVE STE A2
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City | UPLAND
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State | CA
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Zip | 91786-3695
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Country | US
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Telephone | 909-579-0623
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Fax | 909-579-6483
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RUSSEL NOLASCO
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Credential | DDS
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Telephone | 760-201-6519
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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