Healthcare Provider Details

I. General information

NPI: 1083785869
Provider Name (Legal Business Name): CHERYL LYNN NEILSON DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHERYL LYNN MADEJCZYK

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 02/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5430 TUTT BLVD
COLORADO SPRINGS CO
80922-2515
US

IV. Provider business mailing address

18698 E GRAND CIR
AURORA CO
80015-3280
US

V. Phone/Fax

Practice location:
  • Phone: 719-380-0141
  • Fax:
Mailing address:
  • Phone: 702-363-8655
  • Fax: 702-363-3381

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number5071
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDE00011173
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number00202315
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: