MEDICARE: DR. ERIC G. NELSON 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		WA

General Provider Information

NPI Number	:	1538192422
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERIC G. NELSON DDS

Provider Business Mailing Address
First Line	:	204 N AHTANUM AVE
Second Line	:
City	:	WAPATO
State	:	WA
Zip	:	98951-1126
Country	:	US
Telephone Number	:	509-877-4186
Fax Number	:	509-877-6821

Provider Business Practice Location Address
First Line	:	204 N AHTANUM AVE
Second Line	:
City	:	WAPATO
State	:	WA
Zip	:	98951-1126
Country	:	US
Telephone Number	:	509-877-4186
Fax Number	:	509-877-6821

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

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

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