Provider Demographics
NPI:1427003128
Name:NELSON, CASEY LEE (DDS)
Entity Type:Individual
Prefix:DR
First Name:CASEY
Middle Name:LEE
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 1:5101 VERNON AVE S
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55436-2172
Mailing Address - Country:US
Mailing Address - Phone:952-920-9579
Mailing Address - Fax:952-920-9298
Practice Address - Street 1:5101 VERNON AVE S
Practice Address - Street 2:SUITE 1B
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55436-2172
Practice Address - Country:US
Practice Address - Phone:952-920-9579
Practice Address - Fax:952-920-9298
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND12104122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist