Provider Demographics
NPI:1225782261
Name:NELSON AND WILLIS LLC
Entity Type:Organization
Organization Name:NELSON AND WILLIS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BROCK
Authorized Official - Middle Name:
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:503-364-3004
Mailing Address - Street 1:631 JASON ST NE STE 150
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-2318
Mailing Address - Country:US
Mailing Address - Phone:503-364-3004
Mailing Address - Fax:503-364-1623
Practice Address - Street 1:631 JASON ST NE STE 150
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-2318
Practice Address - Country:US
Practice Address - Phone:503-364-3004
Practice Address - Fax:503-364-1623
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-08
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty