Provider Demographics
NPI:1275914871
Name:NELSON, DERRICK COURTNEY (DDS)
Entity Type:Individual
Prefix:DR
First Name:DERRICK
Middle Name:COURTNEY
Last Name:NELSON
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 1:149 BRAUER HALL UNC DENTAL SCHOOL
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27599-9438
Mailing Address - Country:US
Mailing Address - Phone:919-537-3721
Mailing Address - Fax:
Practice Address - Street 1:149 BRAUER HALL UNC DENTAL SCHOOL
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27599-9438
Practice Address - Country:US
Practice Address - Phone:919-537-3944
Practice Address - Fax:919-537-3407
Is Sole Proprietor?:No
Enumeration Date:2015-06-09
Last Update Date:2019-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC100851223S0112X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery