Provider Demographics
NPI:1528018967
Name:NIELSEN, STEVEN F (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:F
Last Name:NIELSEN
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:PO BOX 525
Mailing Address - Street 2:
Mailing Address - City:SHELLEY
Mailing Address - State:ID
Mailing Address - Zip Code:83274-0525
Mailing Address - Country:US
Mailing Address - Phone:208-357-7611
Mailing Address - Fax:208-357-1805
Practice Address - Street 1:371 W FIR ST
Practice Address - Street 2:
Practice Address - City:SHELLEY
Practice Address - State:ID
Practice Address - Zip Code:83274-1456
Practice Address - Country:US
Practice Address - Phone:208-357-7611
Practice Address - Fax:208-357-1805
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD1756122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist