Provider Demographics
NPI:1942553722
Name:STA ANA, NOLASCO T (DMD)
Entity Type:Individual
Prefix:DR
First Name:NOLASCO
Middle Name:T
Last Name:STA ANA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2560 WEST LINCOLN AVENUE
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-6432
Mailing Address - Country:US
Mailing Address - Phone:714-110-9647
Mailing Address - Fax:714-220-0375
Practice Address - Street 1:1252 WEST 6TH STREET
Practice Address - Street 2:SUITE 103
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92882-8207
Practice Address - Country:US
Practice Address - Phone:951-371-7998
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-18
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA035341122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist