Provider Demographics
NPI:1871583856
Name:NELSON, PAUL E (DDS)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:E
Last Name:NELSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2377 MARGARET ST N
Mailing Address - Street 2:
Mailing Address - City:NORTH SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55109-3019
Mailing Address - Country:US
Mailing Address - Phone:651-777-3009
Mailing Address - Fax:651-777-0307
Practice Address - Street 1:2377 MARGARET ST N
Practice Address - Street 2:
Practice Address - City:NORTH SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55109-3019
Practice Address - Country:US
Practice Address - Phone:651-777-3009
Practice Address - Fax:651-777-0307
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8434122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist