Provider Demographics
NPI:1508570623
Name:NELSON, KIRBY MARTIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:KIRBY
Middle Name:MARTIN
Last Name:NELSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:KIRBY
Other - Middle Name:M
Other - Last Name:NELSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:KIRBY M NELSON
Mailing Address - Street 1:26250 238TH LN SE STE 102
Mailing Address - Street 2:
Mailing Address - City:MAPLE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98038-4000
Mailing Address - Country:US
Mailing Address - Phone:425-413-2121
Mailing Address - Fax:425-358-7290
Practice Address - Street 1:26250 238TH LN SE STE 102
Practice Address - Street 2:
Practice Address - City:MAPLE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:98038-4000
Practice Address - Country:US
Practice Address - Phone:425-413-2121
Practice Address - Fax:425-358-7290
Is Sole Proprietor?:No
Enumeration Date:2023-01-12
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000077021223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics