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General NPI Number Information
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NPI Number | 1184762643
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Entity Type | Organization
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Legal Business Name | KEITH T. NELSON, DDS INC
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Dates
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Enumeration Date | 02/04/2007
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Last Update Date | 03/28/2009
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Provider Practice Location Address
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Address Line | 3031 TELEGRAPH AVE SUITE 234
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City | BERKELEY
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State | CA
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Zip | 94705-2051
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Country | US
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Telephone | 510-548-9114
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Fax | 510-548-8046
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Provider Business Mailing Address
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Address Line | 3031 TELEGRAPH AVE SUITE 234
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City | BERKELEY
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State | CA
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Zip | 94705-2051
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Country | US
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Telephone | 510-548-9114
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Fax | 510-548-8046
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MICHELE DECARLO
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Credential |
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Telephone | 510-548-9114
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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 | 28772
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License Number State | CA
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