Provider Demographics
NPI:1417065251
Name:NELSON, JAMES BRIAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:BRIAN
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 1:821 N HWY 99W
Mailing Address - Street 2:
Mailing Address - City:MCMINNVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97378-2738
Mailing Address - Country:US
Mailing Address - Phone:503-472-1159
Mailing Address - Fax:503-434-1679
Practice Address - Street 1:821 N HWY 99W
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97378-2738
Practice Address - Country:US
Practice Address - Phone:503-472-1159
Practice Address - Fax:503-434-1679
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR61881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice