Provider Demographics
NPI:1083618342
Name:CARDON, PAUL NOLAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:NOLAN
Last Name:CARDON
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 1:757W STADIUM BLVD B
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65109-4786
Mailing Address - Country:US
Mailing Address - Phone:573-636-5522
Mailing Address - Fax:573-636-3328
Practice Address - Street 1:325 2ND ST
Practice Address - Street 2:
Practice Address - City:MONUMENT
Practice Address - State:CO
Practice Address - Zip Code:80132-7935
Practice Address - Country:US
Practice Address - Phone:719-481-4949
Practice Address - Fax:719-481-4989
Is Sole Proprietor?:No
Enumeration Date:2005-06-02
Last Update Date:2015-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6400122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist