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General NPI Number Information
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NPI Number | 1801237920
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Entity Type | Individual
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Provider Name | JONATHAN EUGENE NELSON D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/17/2013
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Last Update Date | 12/12/2016
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Provider Practice Location Address
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Address Line | 3700 S RUSSELL ST STE. #116
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City | MISSOULA
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State | MT
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Zip | 59801-8574
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Country | US
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Telephone | 406-542-3305
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Fax | 406-721-3226
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Provider Business Mailing Address
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Address Line | 3700 S RUSSELL ST STE. #116
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City | MISSOULA
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State | MT
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Zip | 59801-8574
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Country | US
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Telephone | 406-542-3305
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Fax | 406-721-3226
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 6667
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License Number State | MT
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