Healthcare Provider Details

I. General information

NPI: 1811067952
Provider Name (Legal Business Name): HOWARD L NELSON DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 11/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1144 OPAL COURT
HAGERSTOWN MD
21740
US

IV. Provider business mailing address

1007 SUSHRUTA DRIVE
MARTINSBURG WV
25401
US

V. Phone/Fax

Practice location:
  • Phone: 301-733-2500
  • Fax: 301-733-9600
Mailing address:
  • Phone: 304-263-0991
  • Fax: 304-274-9546

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number3550
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number12507
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDEN5975
License Number StateDC
# 4
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDS035393
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: