Provider Demographics
NPI:1356640882
Name:NELSON, ZACHARY DOUGLAS (DMD)
Entity Type:Individual
Prefix:DR
First Name:ZACHARY
Middle Name:DOUGLAS
Last Name:NELSON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9652 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80229-2160
Mailing Address - Country:US
Mailing Address - Phone:303-252-4050
Mailing Address - Fax:
Practice Address - Street 1:9652 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80229-2160
Practice Address - Country:US
Practice Address - Phone:303-252-4050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-23
Last Update Date:2016-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011000216122300000X
CA620531223X0400X
CODEN.002019631223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No122300000XDental ProvidersDentist