Provider Demographics
NPI:1225101702
Name:NELLSON, RICHARD HUNTER (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:HUNTER
Last Name:NELLSON
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 1:163 PLEASANT AVENUE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-3242
Mailing Address - Country:US
Mailing Address - Phone:207-773-3794
Mailing Address - Fax:207-772-1011
Practice Address - Street 1:163 PLEASANT AVENUE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103-3242
Practice Address - Country:US
Practice Address - Phone:207-773-3794
Practice Address - Fax:207-772-1011
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME2765122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist