MEDICARE: DR. GARY RANDALL 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	1223P0221X	Pediatric Dentistry	27908	CA
2	1223P0221X	Pediatric Dentistry	D9864	OR

General Provider Information

NPI Number	:	1598746687
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GARY RANDALL NELSON D.D.S.

Provider Business Mailing Address
First Line	:	2730 SW MOODY AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97201-5042
Country	:	US
Telephone Number	:	503-346-4708
Fax Number	:

Provider Business Practice Location Address
First Line	:	2730 SW MOODY AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97201-5042
Country	:	US
Telephone Number	:	503-346-4708
Fax Number	:

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

Provider Enumeration Date	:	11/07/2005
Last Update Date	:	07/22/2014

Similar Medicare Providers

1841148913 — OLIVER DANIEL VALDIVIA CAMACHO
Practice Location Address:

2730 S MOODY AVE
PORTLAND, OR
97201-5042

Practice Phone: 503-494-2998
Practice Fax:

1619974607 — DR. DENNIS CRANDALL NICOLA D.D.S.
Practice Location Address:

2730 SW MOODY AVE
PORTLAND, OR
97201-5042

Practice Phone: 503-346-4725
Practice Fax:

1407857295 — DR. CHARLES J RIM D.D.S.
Practice Location Address:

2730 S MOODY AVE
PORTLAND, OR
97201-5042

Practice Phone: 503-346-4710
Practice Fax:

1760475529 — DR. HOWARD M FREEDMAN DDS,PC
Practice Location Address:

2730 S MOODY AVE
PORTLAND, OR
97201-5042

Practice Phone: 503-494-8921
Practice Fax:

1144213851 — DR. BRIAN WHITTEN DDS
Practice Location Address:

2730 SW MOODY AVE
PORTLAND, OR
97201-5042

Practice Phone: 503-418-1669
Practice Fax: 503-494-8486

1497727911 — PAMELA J HUGHES DDS
Practice Location Address:

2730 SW MOODY AVE
PORTLAND, OR
97201-5042

Practice Phone: 503-494-4461
Practice Fax:

Directions to “ DR. GARY RANDALL NELSON D.D.S.” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.