Healthcare Provider Details

I. General information

NPI: 1447238001
Provider Name (Legal Business Name): DR. DENNIS NELSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2006
Last Update Date: 12/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9132 MASON DRIVE
NEWAYGO MI
49337
US

IV. Provider business mailing address

9132 MASON DRIVE
NEWAYGO MI
49337
US

V. Phone/Fax

Practice location:
  • Phone: 231-652-2900
  • Fax: 231-652-2974
Mailing address:
  • Phone: 231-652-2900
  • Fax: 231-652-2974

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number11845
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: