Provider Demographics
NPI:1083785869
Name:NEILSON, CHERYL LYNN (DMD)
Entity Type:Individual
Prefix:DR
First Name:CHERYL
Middle Name:LYNN
Last Name:NEILSON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:CHERYL
Other - Middle Name:LYNN
Other - Last Name:MADEJCZYK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:18698 E GRAND CIR
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80015-3280
Mailing Address - Country:US
Mailing Address - Phone:702-363-8655
Mailing Address - Fax:702-363-3381
Practice Address - Street 1:5430 TUTT BLVD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80922-2515
Practice Address - Country:US
Practice Address - Phone:719-380-0141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2016-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV5071122300000X
WADE00011173122300000X
CO00202315122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist