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NPI Code Detail

MEDICARE: DR. AMANDA KAY NELSON D.M.D.

MEDICARE: DR. AMANDA KAY 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 DentistryD1121SD

General Provider Information

NPI Number : 1740632389
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. AMANDA KAY NELSON D.M.D.
Provider Business Mailing Address
First Line : 1611 SHERIDAN LAKE RD
Second Line :
City : RAPID CITY
State : SD
Zip : 57702-3423
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1611 SHERIDAN LAKE RD
Second Line :
City : RAPID CITY
State : SD
Zip : 57702-3423
Country : US
Telephone Number : 605-341-3670
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/07/2016
Last Update Date : 07/07/2016

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