Provider Demographics
NPI:1417961517
Name:NELSON, RICHARD DEAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:DEAN
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 1:2430 TECH DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-3258
Mailing Address - Country:US
Mailing Address - Phone:563-332-0415
Mailing Address - Fax:563-332-2979
Practice Address - Street 1:2430 TECH DR
Practice Address - Street 2:SUITE A
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-3258
Practice Address - Country:US
Practice Address - Phone:563-332-0415
Practice Address - Fax:563-332-2979
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA61431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice