Provider Demographics
NPI:1053172106
Name:RUSSEL R. NOLASCO DDS, INC
Entity type:Organization
Organization Name:RUSSEL R. NOLASCO DDS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RUSSEL
Authorized Official - Middle Name:
Authorized Official - Last Name:NOLASCO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:760-201-6519
Mailing Address - Street 1:1042 N MOUNTAIN AVE STE A2
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-3695
Mailing Address - Country:US
Mailing Address - Phone:909-579-0623
Mailing Address - Fax:909-579-6483
Practice Address - Street 1:1042 N MOUNTAIN AVE STE A2
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-3695
Practice Address - Country:US
Practice Address - Phone:909-579-0623
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-17
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty