MEDICARE: JORDAN 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	1223G0001X	General Practice Dentistry	41951	TX
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1891584934
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORDAN NOLAN DMD

Provider Business Mailing Address
First Line	:	2011 E RUBY LN
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85024-8617
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11590 GALM RD STE 105
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78254-4549
Country	:	US
Telephone Number	:	210-672-4200
Fax Number	:

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

Provider Enumeration Date	:	05/05/2025
Last Update Date	:	12/16/2025

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Directions to “ JORDAN NOLAN DMD” Practice Location

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