Healthcare Provider Details

I. General information

NPI: 1306961040
Provider Name (Legal Business Name): JOHN RICK NEILSON D.D.S., M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1909 N GREEN VALLEY PKWY STE A
HENDERSON NV
89074-8353
US

IV. Provider business mailing address

1909 N GREEN VALLEY PKWY STE A
HENDERSON NV
89074-8353
US

V. Phone/Fax

Practice location:
  • Phone: 702-897-1611
  • Fax: 702-897-1396
Mailing address:
  • Phone: 702-897-1611
  • Fax: 702-897-1396

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number2106
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: