Provider Demographics
NPI:1447238001
Name:NELSON, DENNIS
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:
Last Name:NELSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9132 MASON DRIVE
Mailing Address - Street 2:
Mailing Address - City:NEWAYGO
Mailing Address - State:MI
Mailing Address - Zip Code:49337
Mailing Address - Country:US
Mailing Address - Phone:231-652-2900
Mailing Address - Fax:231-652-2974
Practice Address - Street 1:9132 MASON DRIVE
Practice Address - Street 2:
Practice Address - City:NEWAYGO
Practice Address - State:MI
Practice Address - Zip Code:49337
Practice Address - Country:US
Practice Address - Phone:231-652-2900
Practice Address - Fax:231-652-2974
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2015-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI118451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice