MEDICARE: DR. JASON NELSEN 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	7540	NC

General Provider Information

NPI Number	:	1780786483
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JASON NELSEN DDS

Provider Business Mailing Address
First Line	:	7920A MOORES CHAPEL RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28214-9453
Country	:	US
Telephone Number	:	704-392-8199
Fax Number	:

Provider Business Practice Location Address
First Line	:	7920A MOORES CHAPEL RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28214-9453
Country	:	US
Telephone Number	:	704-392-8199
Fax Number	:

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

Provider Enumeration Date	:	09/02/2006
Last Update Date	:	07/08/2007

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