Provider Demographics
NPI:1952145666
Name:NOLAN, LEEANN (DMD)
Entity type:Individual
Prefix:
First Name:LEEANN
Middle Name:
Last Name:NOLAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 DELGADO ST
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87501-2729
Mailing Address - Country:US
Mailing Address - Phone:973-908-5994
Mailing Address - Fax:
Practice Address - Street 1:3569 ZAFARANO DR
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87507-2618
Practice Address - Country:US
Practice Address - Phone:505-986-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-19
Last Update Date:2025-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD012173122300000X, 1223G0001X
NMDB-2024-04001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice