Provider Demographics
NPI:1043033442
Name:NELSON DENTAL PC
Entity type:Organization
Organization Name:NELSON DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:EVAN
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:701-541-3094
Mailing Address - Street 1:910 16TH AVE N
Mailing Address - Street 2:
Mailing Address - City:WAHPETON
Mailing Address - State:ND
Mailing Address - Zip Code:58075-3217
Mailing Address - Country:US
Mailing Address - Phone:701-642-0087
Mailing Address - Fax:701-999-2151
Practice Address - Street 1:910 16TH AVE N
Practice Address - Street 2:
Practice Address - City:WAHPETON
Practice Address - State:ND
Practice Address - Zip Code:58075-3217
Practice Address - Country:US
Practice Address - Phone:701-642-0087
Practice Address - Fax:701-999-2151
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NELSON DENTAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-11-04
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty