MEDICARE: DR. DENNIS JAMES NOLAN DDS

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	122300000X	Dentist	30016592	OH

General Provider Information

NPI Number	:	1033205992
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DENNIS JAMES NOLAN DDS

Provider Business Mailing Address
First Line	:	60 SOUTH CLEVELAND AVE
Second Line	:
City	:	MOGADORE
State	:	OH
Zip	:	44260-1442
Country	:	US
Telephone Number	:	330-628-2424
Fax Number	:	330-628-3533

Provider Business Practice Location Address
First Line	:	60 SOUTH CLEVELAND AVE
Second Line	:
City	:	MOGADORE
State	:	OH
Zip	:	44260-1442
Country	:	US
Telephone Number	:	330-628-2424
Fax Number	:	330-628-3533

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/05/2006
Last Update Date	:	07/08/2007

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