Provider Demographics
NPI:1417041880
Name:NOKELBY, BRYAN NOEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:NOEL
Last Name:NOKELBY
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 1:2291 SOSCOL AVE
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-3620
Mailing Address - Country:US
Mailing Address - Phone:707-226-2627
Mailing Address - Fax:707-226-5730
Practice Address - Street 1:2291 SOSCOL AVE
Practice Address - Street 2:
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-3620
Practice Address - Country:US
Practice Address - Phone:707-226-2627
Practice Address - Fax:707-226-5730
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA429411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice