MEDICARE: DR. JOSEPH WILLIAM NOLAN DMD

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	D5638	OR

General Provider Information

NPI Number	:	1427057488
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSEPH WILLIAM NOLAN DMD

Provider Business Mailing Address
First Line	:	19157 WILLAMETTE DR
Second Line	:
City	:	WEST LINN
State	:	OR
Zip	:	97068-2019
Country	:	US
Telephone Number	:	503-635-4493
Fax Number	:	503-635-6038

Provider Business Practice Location Address
First Line	:	19157 WILLAMETTE DR
Second Line	:
City	:	WEST LINN
State	:	OR
Zip	:	97068-2019
Country	:	US
Telephone Number	:	503-635-4493
Fax Number	:	503-635-6038

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

Provider Enumeration Date	:	07/20/2005
Last Update Date	:	07/08/2007

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