Provider Demographics
NPI:1548398407
Name:NELSON, PAUL A (DDS MSD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:A
Last Name:NELSON
Suffix:
Gender:M
Credentials:DDS MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7556 15TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98117-5409
Mailing Address - Country:US
Mailing Address - Phone:206-784-5372
Mailing Address - Fax:206-784-6389
Practice Address - Street 1:7556 15TH AVE NW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98117-5409
Practice Address - Country:US
Practice Address - Phone:206-784-5372
Practice Address - Fax:206-784-6389
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA68741223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics