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General NPI Number Information
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NPI Number | 1457354458
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Entity Type | Individual
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Provider Name | JOHN WILLIAM NELSON JR. D.D.S., M.P.A.
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Gender | Male
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Dates
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Enumeration Date | 05/23/2005
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Last Update Date | 11/28/2012
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Provider Practice Location Address
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Address Line | 650 E 25TH ST
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City | KANSAS CITY
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State | MO
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Zip | 64108-2716
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Country | US
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Telephone | 816-235-2100
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Fax |
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Provider Business Mailing Address
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Address Line | 310 W 49TH ST APT 405
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City | KANSAS CITY
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State | MO
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Zip | 64112-2515
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Country | US
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Telephone | 816-753-9775
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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 | 13688
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License Number State | MO
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