Provider Demographics
NPI:1174744486
Name:NOLAN, MICHAEL J (DDS)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:J
Last Name:NOLAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3633 W. LAKE AVE.
Mailing Address - Street 2:STE. #414
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60026-5804
Mailing Address - Country:US
Mailing Address - Phone:847-724-6222
Mailing Address - Fax:847-724-6263
Practice Address - Street 1:3633 W. LAKE AVE.
Practice Address - Street 2:STE. #414
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60026-5804
Practice Address - Country:US
Practice Address - Phone:847-724-6222
Practice Address - Fax:847-724-6263
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-0217501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice