MEDICARE: PAUL E. 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	122300000X	Dentist	8434	MN

General Provider Information

NPI Number	:	1871583856
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAUL E. NELSON D.D.S.

Provider Business Mailing Address
First Line	:	2377 MARGARET ST N
Second Line	:
City	:	NORTH SAINT PAUL
State	:	MN
Zip	:	55109-3019
Country	:	US
Telephone Number	:	651-777-3009
Fax Number	:	651-777-0307

Provider Business Practice Location Address
First Line	:	2377 MARGARET ST N
Second Line	:
City	:	NORTH SAINT PAUL
State	:	MN
Zip	:	55109-3019
Country	:	US
Telephone Number	:	651-777-3009
Fax Number	:	651-777-0307

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

Provider Enumeration Date	:	10/21/2005
Last Update Date	:	07/09/2007

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