Provider Demographics
NPI:1376593640
Name:NELSON, ERIC WEBB (MD, DDS)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:WEBB
Last Name:NELSON
Suffix:
Gender:M
Credentials:MD, DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:3003 W MAIN ST STE 130
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-2026
Mailing Address - Country:US
Mailing Address - Phone:208-342-7610
Mailing Address - Fax:208-344-1799
Practice Address - Street 1:3003 W MAIN ST STE 130
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-2026
Practice Address - Country:US
Practice Address - Phone:208-342-7610
Practice Address - Fax:208-344-1799
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2018-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD-3420-OS1223P0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial Pathology