Provider Demographics
NPI:1518463892
Name:NELSON DENTAL CLINIC PC
Entity Type:Organization
Organization Name:NELSON DENTAL CLINIC PC
Other - Org Name:SISSETON DENTAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:EVAN
Authorized Official - Middle Name:
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:605-698-3201
Mailing Address - Street 1:7 SUMMIT ST
Mailing Address - Street 2:
Mailing Address - City:SISSETON
Mailing Address - State:SD
Mailing Address - Zip Code:57262-2305
Mailing Address - Country:US
Mailing Address - Phone:605-698-3201
Mailing Address - Fax:605-698-4799
Practice Address - Street 1:7 SUMMIT ST
Practice Address - Street 2:
Practice Address - City:SISSETON
Practice Address - State:SD
Practice Address - Zip Code:57262-2305
Practice Address - Country:US
Practice Address - Phone:605-698-3201
Practice Address - Fax:605-698-4799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-04
Last Update Date:2018-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty