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NPI Code Detail

MEDICARE: PAUL E. NELSON D.D.S.

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
11223G0001XGeneral Practice Dentistry

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1871755991
Entity Type Code : Organization
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 : OWNER/DENTIST
Name : DR. PAUL E. NELSON
Credential : D.D.S.
Telephone Number : 651-777-3009
Provider Enumeration Date : 06/30/2008
Last Update Date : 06/30/2008

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