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NPI Code Detail

MEDICARE: DR. DANE JOSEPH NELSON D.M.D.

MEDICARE:  DR. DANE JOSEPH NELSON  D.M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry7579281-9922UT

General Provider Information

NPI Number : 1114377744
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DANE JOSEPH NELSON D.M.D.
Provider Business Mailing Address
First Line : 5872 S 900 E STE 202
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84121-1682
Country : US
Telephone Number : 801-281-8433
Fax Number : 801-281-8455
Provider Business Practice Location Address
First Line : 5872 S 900 E STE 202
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84121-1682
Country : US
Telephone Number : 801-281-8433
Fax Number : 801-281-8455
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/14/2016
Last Update Date : 06/14/2016

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Directions to “ DR. DANE JOSEPH NELSON D.M.D.” Practice Location

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