Russel Rovira Nolasco, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

103537 Issued in CA

Practice address

1042 N Mountain Ave Ste A2
Upland, CA 91786-3695

Phone

(909) 579-0623

Fax

(909) 579-6483

NPI assigned

Feb 11, 2019

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Russel R. Nolasco DDS, Inc

  • General Practice Dentistry
  • Upland, CA
  • NPI 1053172106
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1549843200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727654400000",
    "number": "1295291516",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "41410 JUNIPER ST UNIT 3012",
            "city": "MURRIETA",
            "state": "CA",
            "postal_code": "925627516",
            "telephone_number": "760-201-6519"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1042 N MOUNTAIN AVE STE A2",
            "city": "UPLAND",
            "state": "CA",
            "postal_code": "917863695",
            "telephone_number": "909-579-0623",
            "fax_number": "909-579-6483"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NOLASCO",
        "first_name": "RUSSEL",
        "middle_name": "ROVIRA",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-02-11",
        "last_updated": "2024-09-30",
        "certification_date": "2024-09-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "103537",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jessica Nicolle
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• Siavash Nikkhou, DC., MS., QME
• Holly Lynn Nikodym, FNP
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• Norina Murphy MSW, LCSW & Associates
• Tiffany Marie Norris
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• Thia M Norton Bell
• Nova Home Health Inc.

• General Practice Dentistry in Upland, CA
• Providers in Upland, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.