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NPI Code Detail

MEDICARE: DR. GREGORY M NIELSEN DDS

MEDICARE: DR. GREGORY M 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
1204E00000XOral & Maxillofacial Surgery (D.M.D.)2901014950MI

Other Identifiers

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

General Provider Information

NPI Number : 1518949742
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. GREGORY M NIELSEN DDS
Provider Business Mailing Address
First Line : 26111 WOODWARD AVE
Second Line :
City : HUNTINGTON WOODS
State : MI
Zip : 48070-1330
Country : US
Telephone Number : 248-547-8833
Fax Number : 248-547-8836
Provider Business Practice Location Address
First Line : 26111 WOODWARD AVE
Second Line :
City : HUNTINGTON WOODS
State : MI
Zip : 48070-1330
Country : US
Telephone Number : 248-547-8833
Fax Number : 248-547-8836
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/15/2005
Last Update Date : 07/08/2007

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