Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 27387 | TX |
NPI | 1124278676 |
---|---|
Provider Name | Dr. Nolan Joseph Laborde III |
First Address | Fort Worth, TX 76107-6803 |
Second Address | Fort Worth, TX 76107-6803 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2008 |
Last Update Date | 19/12/2016 |