Provider Demographics
NPI:1437237641
Name:NOLAN, MICHAEL FRANKLIN SR (DDS)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:FRANKLIN
Last Name:NOLAN
Suffix:SR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2511 BROADMOOR BLVD
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-2987
Mailing Address - Country:US
Mailing Address - Phone:318-322-2013
Mailing Address - Fax:318-322-2048
Practice Address - Street 1:1101 ROYAL AVE SUITE B
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201
Practice Address - Country:US
Practice Address - Phone:318-323-9655
Practice Address - Fax:318-323-9698
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2009-04-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA28541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice