Provider Demographics
NPI:1043389752
Name:NELSON, JEFFREY D (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:D
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:PO BOX 77
Mailing Address - Street 2:117 N MAIN
Mailing Address - City:OWENSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47665
Mailing Address - Country:US
Mailing Address - Phone:812-724-4145
Mailing Address - Fax:812-724-4145
Practice Address - Street 1:117 N MAIN
Practice Address - Street 2:
Practice Address - City:OWENSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47665
Practice Address - Country:US
Practice Address - Phone:812-724-4145
Practice Address - Fax:812-724-4145
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12009411122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist