Provider Demographics
NPI:1932115193
Name:NOLT, MARVIN BENNER (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARVIN
Middle Name:BENNER
Last Name:NOLT
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 1:1221 DIVISION HWY
Mailing Address - Street 2:
Mailing Address - City:EPHRATA
Mailing Address - State:PA
Mailing Address - Zip Code:17522-8822
Mailing Address - Country:US
Mailing Address - Phone:717-738-1737
Mailing Address - Fax:
Practice Address - Street 1:1261 DIVISION HWY
Practice Address - Street 2:
Practice Address - City:EPHRATA
Practice Address - State:PA
Practice Address - Zip Code:17522-8822
Practice Address - Country:US
Practice Address - Phone:717-738-1353
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS20423L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice