MEDICARE: DR. DAVID L N IELSON 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	AA659	AK

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

General Provider Information

NPI Number	:	1528088358
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID L N IELSON DDS

Provider Business Mailing Address
First Line	:	6222 W DIMOND BLVD
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99502-4006
Country	:	US
Telephone Number	:	907-441-6002
Fax Number	:

Provider Business Practice Location Address
First Line	:	6222 W DIMOND BLVD
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99502-4006
Country	:	US
Telephone Number	:	907-244-4125
Fax Number	:

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

Provider Enumeration Date	:	07/21/2006
Last Update Date	:	03/11/2016

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Directions to “ DR. DAVID L N IELSON DDS” Practice Location

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