Provider Demographics
NPI:1306922588
Name:NOLAN, GREGG S (DDS)
Entity type:Individual
Prefix:MR
First Name:GREGG
Middle Name:S
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 1:2020 BABROCK
Mailing Address - Street 2:STE 15
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229
Mailing Address - Country:US
Mailing Address - Phone:210-616-0848
Mailing Address - Fax:210-692-9044
Practice Address - Street 1:2020 BABROCK
Practice Address - Street 2:STE 15
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229
Practice Address - Country:US
Practice Address - Phone:210-616-0848
Practice Address - Fax:210-692-9044
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX149651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice