MEDICARE: BETHANY R NIELSEN 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
1	1223G0001X	General Practice Dentistry	D0615	SD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265514681
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BETHANY R NIELSEN DDS

Provider Business Mailing Address
First Line	:	320 DAKOTA DUNES BLVD
Second Line	:	APT #108
City	:	DAKOTA DUNES
State	:	SD
Zip	:	57049-5340
Country	:	US
Telephone Number	:	605-422-1413
Fax Number	:

Provider Business Practice Location Address
First Line	:	101 MERRILL AVE, BOX 1010
Second Line	:
City	:	NORTH SIOUX CITY
State	:	SD
Zip	:	57049
Country	:	US
Telephone Number	:	605-232-8802
Fax Number	:	605-232-0973

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/19/2006
Last Update Date	:	07/08/2007

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