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NPI Code Detail

MEDICARE: DR. NELSON HENRY DDS

MEDICARE: DR. NELSON HENRY DDS
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
1122300000XDentist016072MO

General Provider Information

NPI Number : 1003978412
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. NELSON HENRY DDS
Provider Business Mailing Address
First Line : 3306 EMERALD LN
Second Line :
City : JEFFERSON CITY
State : MO
Zip : 65109-6877
Country : US
Telephone Number : 573-634-2222
Fax Number : 573-634-8812
Provider Business Practice Location Address
First Line : 3306 EMERALD LN
Second Line :
City : JEFFERSON CITY
State : MO
Zip : 65109-6877
Country : US
Telephone Number : 573-634-2222
Fax Number : 573-634-8812
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/14/2006
Last Update Date : 07/08/2007

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