Provider Demographics
NPI:1568854040
Name:NOLAND DENTAL LLC
Entity Type:Organization
Organization Name:NOLAND DENTAL LLC
Other - Org Name:PAUL BROOKS NOLAND DMD
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DENTIST/MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:BROOKS
Authorized Official - Last Name:NOLAND
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:503-789-8465
Mailing Address - Street 1:PO BOX 8646
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97207-8646
Mailing Address - Country:US
Mailing Address - Phone:503-789-8465
Mailing Address - Fax:503-646-8123
Practice Address - Street 1:12400 SW ALLEN BLVD
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-4839
Practice Address - Country:US
Practice Address - Phone:503-789-8465
Practice Address - Fax:503-646-8123
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-20
Last Update Date:2015-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR9092122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty