Provider Demographics
NPI:1255854758
Name:ZACHARY D NELSON DMD DENTAL CORPORATION
Entity Type:Organization
Organization Name:ZACHARY D NELSON DMD DENTAL CORPORATION
Other - Org Name:NELSON FAMILY ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ZACHARY
Authorized Official - Middle Name:
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD MS
Authorized Official - Phone:801-592-6777
Mailing Address - Street 1:950 BOARDWALK STE 104
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92078-2600
Mailing Address - Country:US
Mailing Address - Phone:760-290-3932
Mailing Address - Fax:
Practice Address - Street 1:950 BOARDWALK STE 104
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92078-2600
Practice Address - Country:US
Practice Address - Phone:760-290-3932
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-18
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1012401223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty