Healthcare Provider Details

I. General information

NPI: 1629016308
Provider Name (Legal Business Name): DANIEL C NIELSON DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 11/12/2021
Certification Date: 11/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

965 N MUR LEN RD
OLATHE KS
66062-1861
US

IV. Provider business mailing address

965 N MUR LEN RD
OLATHE KS
66062-1861
US

V. Phone/Fax

Practice location:
  • Phone: 913-706-0068
  • Fax:
Mailing address:
  • Phone: 913-780-3100
  • Fax: 913-780-3101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number60141
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: