Healthcare Provider Details

I. General information

NPI: 1679587281
Provider Name (Legal Business Name): JOHN F NELSON D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 SCRIPPS DR SUITE 302
SACRAMENTO CA
95825-6206
US

IV. Provider business mailing address

1 SCRIPPS DR SUITE 302
SACRAMENTO CA
95825-6206
US

V. Phone/Fax

Practice location:
  • Phone: 916-923-1696
  • Fax: 916-923-1614
Mailing address:
  • Phone: 916-923-1696
  • Fax: 916-923-1614

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number35769
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: