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General NPI Number Information
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NPI Number | 1871704767
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Entity Type | Organization
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Legal Business Name | NIELSON FAMILY DENTISTRY
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Dates
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Enumeration Date | 05/24/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 16500 INDIAN CREEK PKWY SUITE 100
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City | OLATHE
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State | KS
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Zip | 66062-1370
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Country | US
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Telephone | 913-829-8700
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Fax | 913-829-8703
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Provider Business Mailing Address
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Address Line | 16500 INDIAN CREEK PKWY SUITE 100
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City | OLATHE
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State | KS
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Zip | 66062-1370
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Country | US
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Telephone | 913-829-8700
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Fax | 913-829-8703
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Authorized Official
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Title or Position | DENTIST
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Name | MR. DONALD C NIELSON
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Credential | DDS
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Telephone | 913-829-8700
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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 | 5119
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License Number State | KS
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