Provider Demographics
NPI:1003023904
Name:BRADLELY J. NELSON D.D.S. LTD
Entity Type:Organization
Organization Name:BRADLELY J. NELSON D.D.S. LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:J
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:702-734-8376
Mailing Address - Street 1:860 E SAHARA AVE
Mailing Address - Street 2:#2
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89104-3032
Mailing Address - Country:US
Mailing Address - Phone:702-734-8376
Mailing Address - Fax:702-734-8520
Practice Address - Street 1:860 E SAHARA AVE
Practice Address - Street 2:#2
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89104-3032
Practice Address - Country:US
Practice Address - Phone:702-734-8376
Practice Address - Fax:702-734-8520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV6901223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty