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General NPI Number Information
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NPI Number | 1518463892
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Entity Type | Organization
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Legal Business Name | NELSON DENTAL CLINIC PC
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Dates
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Enumeration Date | 04/04/2018
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Last Update Date | 04/04/2018
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Provider Practice Location Address
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Address Line | 7 SUMMIT ST
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City | SISSETON
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State | SD
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Zip | 57262-2305
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Country | US
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Telephone | 605-698-3201
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Fax | 605-698-4799
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Provider Business Mailing Address
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Address Line | 7 SUMMIT ST
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City | SISSETON
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State | SD
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Zip | 57262-2305
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Country | US
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Telephone | 605-698-3201
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Fax | 605-698-4799
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. EVAN NELSON
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Credential | DDS
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Telephone | 605-698-3201
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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 |
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License Number State |
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