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General NPI Number Information
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NPI Number | 1568854040
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Entity Type | Organization
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Legal Business Name | NOLAND DENTAL LLC
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Dates
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Enumeration Date | 02/20/2015
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Last Update Date | 02/20/2015
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Provider Practice Location Address
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Address Line | 12400 SW ALLEN BLVD
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City | BEAVERTON
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State | OR
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Zip | 97005-4839
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Country | US
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Telephone | 503-789-8465
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Fax | 503-646-8123
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Provider Business Mailing Address
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Address Line | PO BOX 8646
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City | PORTLAND
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State | OR
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Zip | 97207-8646
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Country | US
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Telephone | 503-789-8465
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Fax | 503-646-8123
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Authorized Official
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Title or Position | DENTIST/MANAGING MEMBER
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Name | DR. PAUL BROOKS NOLAND
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Credential | DMD
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Telephone | 503-789-8465
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 9092
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License Number State | OR
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