Provider Demographics
NPI:1003912916
Name:NELSON, DAVID EUGENE (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:EUGENE
Last Name:NELSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3714 GREATLAND ST
Mailing Address - Street 2:
Mailing Address - City:HOMER
Mailing Address - State:AK
Mailing Address - Zip Code:99603-7522
Mailing Address - Country:US
Mailing Address - Phone:907-235-8845
Mailing Address - Fax:907-235-8841
Practice Address - Street 1:3714 GREATLAND STREET
Practice Address - Street 2:
Practice Address - City:HOMER
Practice Address - State:AK
Practice Address - Zip Code:99603-7522
Practice Address - Country:US
Practice Address - Phone:907-235-8845
Practice Address - Fax:907-235-8841
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2511122300000X
AK1184122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist