Provider Demographics
NPI:1306179239
Name:NELSON, CHRISTOPHER DAVID (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:DAVID
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:PO BOX 228
Mailing Address - Street 2:
Mailing Address - City:ROUND MOUNTAIN
Mailing Address - State:CA
Mailing Address - Zip Code:96084-0228
Mailing Address - Country:US
Mailing Address - Phone:530-337-5750
Mailing Address - Fax:530-337-5754
Practice Address - Street 1:29632 HIGHWAY 299 EAST
Practice Address - Street 2:
Practice Address - City:ROUND MOUNTAIN
Practice Address - State:CA
Practice Address - Zip Code:96084
Practice Address - Country:US
Practice Address - Phone:530-337-5750
Practice Address - Fax:530-337-5754
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-10
Last Update Date:2009-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA58551122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist