Provider Demographics
NPI:1508196437
Name:NELSON, PETER S (DDS)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:S
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 1:5750 W THUNDERBIRD RD STE H850
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85306-4694
Mailing Address - Country:US
Mailing Address - Phone:402-990-3457
Mailing Address - Fax:
Practice Address - Street 1:5750 W THUNDERBIRD RD STE H850
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-4694
Practice Address - Country:US
Practice Address - Phone:602-938-0880
Practice Address - Fax:602-547-0528
Is Sole Proprietor?:No
Enumeration Date:2009-12-25
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYAB34335312181223S0112X
AZ90951223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery