Healthcare Provider Details

I. General information

NPI: 1578583654
Provider Name (Legal Business Name): WILLIAM J NELSON DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 09/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2581 DEVELOPMENT DR
GREEN BAY WI
54311-4247
US

IV. Provider business mailing address

2581 DEVELOPMENT DR
GREEN BAY WI
54311-4247
US

V. Phone/Fax

Practice location:
  • Phone: 920-347-0400
  • Fax: 920-347-0868
Mailing address:
  • Phone: 920-347-0400
  • Fax: 920-347-0868

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number2782
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: