Provider Demographics
NPI:1003036476
Name:NIELSEN, DANE BUSS (DDS)
Entity Type:Individual
Prefix:DR
First Name:DANE
Middle Name:BUSS
Last Name:NIELSEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5700 RALSTON ST
Mailing Address - Street 2:STE. 303
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-6050
Mailing Address - Country:US
Mailing Address - Phone:805-656-8884
Mailing Address - Fax:805-642-5621
Practice Address - Street 1:5700 RALSTON ST
Practice Address - Street 2:STE. 303
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-6050
Practice Address - Country:US
Practice Address - Phone:805-656-8884
Practice Address - Fax:805-642-5621
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA264951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice