Provider Demographics
NPI:1578600318
Name:NIELSEN, GREGORY JAMES (DDS)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:JAMES
Last Name:NIELSEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4194 BAINBRIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59106-2421
Mailing Address - Country:US
Mailing Address - Phone:702-869-2800
Mailing Address - Fax:702-869-2803
Practice Address - Street 1:2225 BROADWATER AVE STE A
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-4707
Practice Address - Country:US
Practice Address - Phone:702-869-2800
Practice Address - Fax:702-869-2803
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT114991223E0200X
NV47021223G0001X
CO88061223G0001X, 1223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No1223G0001XDental ProvidersDentistGeneral Practice