Provider Demographics
NPI:1558489559
Name:NEILSON, BARBARA L (DMD)
Entity Type:Individual
Prefix:DR
First Name:BARBARA
Middle Name:L
Last Name:NEILSON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 W CHESTER PIKE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:HAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19083-4530
Mailing Address - Country:US
Mailing Address - Phone:610-789-9400
Mailing Address - Fax:610-789-2841
Practice Address - Street 1:301 W CHESTER PIKE
Practice Address - Street 2:SUITE 202
Practice Address - City:HAVERTOWN
Practice Address - State:PA
Practice Address - Zip Code:19083-4530
Practice Address - Country:US
Practice Address - Phone:610-789-9400
Practice Address - Fax:610-789-2841
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS021747L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice