Provider Demographics
NPI:1053679316
Name:B.C. NELSON, D.D.S.
Entity Type:Organization
Organization Name:B.C. NELSON, D.D.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:B.C.
Authorized Official - Middle Name:
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:503-769-5210
Mailing Address - Street 1:470 E. WASHINGTON ST.
Mailing Address - Street 2:
Mailing Address - City:STAYON
Mailing Address - State:OR
Mailing Address - Zip Code:97383-1837
Mailing Address - Country:US
Mailing Address - Phone:503-769-5210
Mailing Address - Fax:503-769-9172
Practice Address - Street 1:470 E. WASHINGTON ST.
Practice Address - Street 2:
Practice Address - City:STAYON
Practice Address - State:OR
Practice Address - Zip Code:97383-1837
Practice Address - Country:US
Practice Address - Phone:503-769-5210
Practice Address - Fax:503-769-9172
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-24
Last Update Date:2012-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD6700122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty