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General NPI Number Information
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NPI Number | 1053679316
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Entity Type | Organization
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Legal Business Name | B.C. NELSON, D.D.S.
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Dates
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Enumeration Date | 04/24/2012
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Last Update Date | 04/24/2012
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Provider Practice Location Address
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Address Line | 470 E. WASHINGTON ST.
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City | STAYON
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State | OR
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Zip | 97383-1837
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Country | US
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Telephone | 503-769-5210
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Fax | 503-769-9172
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Provider Business Mailing Address
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Address Line | 470 E. WASHINGTON ST.
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City | STAYON
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State | OR
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Zip | 97383-1837
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Country | US
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Telephone | 503-769-5210
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Fax | 503-769-9172
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Authorized Official
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Title or Position | OWNER
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Name | B.C. NELSON
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Credential | D.D.S.
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Telephone | 503-769-5210
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | D6700
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License Number State | OR
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