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General NPI Number Information
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NPI Number | 1457285371
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Entity Type | Individual
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Provider Name | JONATHAN WILLIAM NELSON DMD
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Gender | Male
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Dates
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Enumeration Date | 06/09/2026
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Last Update Date | 06/09/2026
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Provider Practice Location Address
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Address Line | 2779 W 4000 S STE 101
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City | ROY
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State | UT
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Zip | 84067-9603
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Country | US
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Telephone | 801-731-5528
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Fax |
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Provider Business Mailing Address
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Address Line | 1943 S 875 E
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City | CLEARFIELD
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State | UT
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Zip | 84015-6265
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Country | US
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Telephone | 801-731-5528
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 14290632-9923
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License Number State | UT
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