Provider Demographics
NPI:1750337002
Name:NOLAN, AARON J (DDS)
Entity type:Individual
Prefix:DR
First Name:AARON
Middle Name:J
Last Name:NOLAN
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 1:3150 ERIE BLVD E
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13214-1303
Mailing Address - Country:US
Mailing Address - Phone:315-446-7442
Mailing Address - Fax:
Practice Address - Street 1:3150 ERIE BLVD E
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13214-1288
Practice Address - Country:US
Practice Address - Phone:315-446-7442
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDEN029291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIAN61481Medicaid
CT003124609OtherEDS
RI7002410OtherEDS
RI7002410OtherEDS
CT003124609OtherEDS