Provider Demographics
NPI:1841604428
Name:NOLAN CREEK DENTAL PLLC
Entity Type:Organization
Organization Name:NOLAN CREEK DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JESSE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:BOWLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:254-300-8804
Mailing Address - Street 1:1237 COUNTY ROAD 197
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:TX
Mailing Address - Zip Code:76538-1207
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:404 E 6TH AVE
Practice Address - Street 2:
Practice Address - City:BELTON
Practice Address - State:TX
Practice Address - Zip Code:76513-2668
Practice Address - Country:US
Practice Address - Phone:254-939-3748
Practice Address - Fax:254-939-1150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-11
Last Update Date:2014-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty