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General NPI Number Information
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NPI Number | 1215947304
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Entity Type | Organization
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Legal Business Name | MILLENNIUM DENTAL, PLLC
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Dates
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Enumeration Date | 08/09/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2827 E MILLENNIUM PL STE 3
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City | FAYETTEVILLE
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State | AR
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Zip | 72703-6528
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Country | US
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Telephone | 479-521-4440
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Fax | 479-521-4443
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Provider Business Mailing Address
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Address Line | 2827 E MILLENNIUM PL STE 3
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City | FAYETTEVILLE
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State | AR
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Zip | 72703-6528
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Country | US
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Telephone | 479-521-4440
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Fax | 479-521-4443
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Authorized Official
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Title or Position | DENTIST
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Name | DR. MICHAEL S NELSON
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Credential | D.D.S.
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Telephone | 479-521-4440
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | AR3216
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License Number State | AR
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