Provider Demographics
NPI:1447399803
Name:NELSON, BRADLEY JEROME (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:JEROME
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 1:860 E SAHARA AVE
Mailing Address - Street 2:#2
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89104-3032
Mailing Address - Country:US
Mailing Address - Phone:702-734-8376
Mailing Address - Fax:702-734-8520
Practice Address - Street 1:860 E SAHARA AVE
Practice Address - Street 2:#2
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89104-3032
Practice Address - Country:US
Practice Address - Phone:702-734-8376
Practice Address - Fax:702-734-8520
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV6901223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics