Provider Demographics
NPI:1811082944
Name:NOLLEY, S.E. (DDS)
Entity type:Individual
Prefix:DR
First Name:S.E.
Middle Name:
Last Name:NOLLEY
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 1:3767 FOREST LN
Mailing Address - Street 2:SUITE 103
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75244-7100
Mailing Address - Country:US
Mailing Address - Phone:972-247-4298
Mailing Address - Fax:972-247-4497
Practice Address - Street 1:3767 FOREST LN
Practice Address - Street 2:SUITE 103
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75244-7100
Practice Address - Country:US
Practice Address - Phone:972-247-4298
Practice Address - Fax:972-247-4497
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX73111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice