MEDICARE: DR. JAMES SHELDON NIELSEN 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	25080	TX

General Provider Information

NPI Number	:	1609017102
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES SHELDON NIELSEN D.D.S.

Provider Business Mailing Address
First Line	:	1286 WEST VAN ALSTYNE PARKWAY
Second Line	:
City	:	VAN ALSTYNE
State	:	TX
Zip	:	75495-8055
Country	:	US
Telephone Number	:	903-712-4440
Fax Number	:	903-712-4441

Provider Business Practice Location Address
First Line	:	1286 WEST VAN ALSTYNE PARKWAY
Second Line	:
City	:	VAN ALSTYNE
State	:	TX
Zip	:	75495-8055
Country	:	US
Telephone Number	:	903-712-4440
Fax Number	:	903-712-4441

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

Provider Enumeration Date	:	03/12/2009
Last Update Date	:	07/24/2015

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