MEDICARE: DR. CHRISTOPHER DAVID NELSON D.D.S.

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	122300000X	Dentist	58551	CA

General Provider Information

NPI Number	:	1306179239
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTOPHER DAVID NELSON D.D.S.

Provider Business Mailing Address
First Line	:	PO BOX 228
Second Line	:
City	:	ROUND MOUNTAIN
State	:	CA
Zip	:	96084-0228
Country	:	US
Telephone Number	:	530-337-5750
Fax Number	:	530-337-5754

Provider Business Practice Location Address
First Line	:	29632 HIGHWAY 299 EAST
Second Line	:
City	:	ROUND MOUNTAIN
State	:	CA
Zip	:	96084
Country	:	US
Telephone Number	:	530-337-5750
Fax Number	:	530-337-5754

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

Provider Enumeration Date	:	09/10/2009
Last Update Date	:	09/10/2009

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Directions to “ DR. CHRISTOPHER DAVID NELSON D.D.S.” Practice Location

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