Healthcare Provider Details

I. General information

NPI: 1871502872
Provider Name (Legal Business Name): CARON LOUISE NELSON DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26425 NE ALLEN ST SUITE 102
DUVALL WA
98019-8612
US

IV. Provider business mailing address

15030 232ND AVE NE
WOODINVILLE WA
98077-7222
US

V. Phone/Fax

Practice location:
  • Phone: 425-788-1551
  • Fax:
Mailing address:
  • Phone: 425-788-1551
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number6329
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: