Provider Demographics
NPI:1558474031
Name:NOLOP, CHARLES ROGER (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:ROGER
Last Name:NOLOP
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 1:101 LAKE ST WEST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WAYZATA
Mailing Address - State:MN
Mailing Address - Zip Code:55391
Mailing Address - Country:US
Mailing Address - Phone:952-473-9421
Mailing Address - Fax:952-473-9414
Practice Address - Street 1:101 LAKE ST WEST
Practice Address - Street 2:SUITE 200
Practice Address - City:WAYZATA
Practice Address - State:MN
Practice Address - Zip Code:55391
Practice Address - Country:US
Practice Address - Phone:952-473-9421
Practice Address - Fax:952-473-9414
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7118122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist