Healthcare Provider Details

I. General information

NPI: 1013807981
Provider Name (Legal Business Name): SUMMERHILLS NIELSON PDC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2025
Last Update Date: 11/06/2025
Certification Date: 11/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2261 N RAMPART BLVD
LAS VEGAS NV
89128-7640
US

IV. Provider business mailing address

727 E UTAH VALLEY DR
AMERICAN FORK UT
84003-3345
US

V. Phone/Fax

Practice location:
  • Phone: 702-363-8655
  • Fax:
Mailing address:
  • Phone: 801-691-1701
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: MARK CHRISTENSEN
Title or Position: CREDENTIALING
Credential:
Phone: 801-691-1701