Provider Demographics
NPI:1285063206
Name:NOLAN, SEAN (DDS)
Entity type:Individual
Prefix:
First Name:SEAN
Middle Name:
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 1:2528 S BROADWAY STE C
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-7879
Mailing Address - Country:US
Mailing Address - Phone:805-925-2628
Mailing Address - Fax:
Practice Address - Street 1:2528 S BROADWAY STE C
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-7879
Practice Address - Country:US
Practice Address - Phone:805-925-2628
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-12
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA627171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice