MEDICARE: BRADLELY J. NELSON D.D.S. LTD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223E0200X	Endodontics	690	NV

General Provider Information

NPI Number	:	1003023904
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRADLELY J. NELSON D.D.S. LTD

Provider Business Mailing Address
First Line	:	860 E SAHARA AVE
Second Line	:	#2
City	:	LAS VEGAS
State	:	NV
Zip	:	89104-3032
Country	:	US
Telephone Number	:	702-734-8376
Fax Number	:	702-734-8520

Provider Business Practice Location Address
First Line	:	860 E SAHARA AVE
Second Line	:	#2
City	:	LAS VEGAS
State	:	NV
Zip	:	89104-3032
Country	:	US
Telephone Number	:	702-734-8376
Fax Number	:	702-734-8520

Authorized Official
Title or Position	:	OWNER
Name	:	DR. BRADLEY J NELSON
Credential	:	D.D.S.
Telephone Number	:	702-734-8376

Provider Enumeration Date	:	05/17/2007
Last Update Date	:	08/22/2020

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