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General NPI Number Information
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NPI Number | 1942553722
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Entity Type | Individual
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Provider Name | NOLASCO T STA ANA D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/18/2012
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Last Update Date | 10/18/2012
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Provider Practice Location Address
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Address Line | 1252 WEST 6TH STREET SUITE 103
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City | CORONA
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State | CA
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Zip | 92882-8207
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Country | US
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Telephone | 951-371-7998
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Fax |
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Provider Business Mailing Address
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Address Line | 2560 WEST LINCOLN AVENUE
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City | ANAHEIM
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State | CA
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Zip | 92801-6432
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Country | US
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Telephone | 714-110-9647
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Fax | 714-220-0375
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 035341
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License Number State | CA
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