Provider Demographics
NPI:1598822330
Name:NELSON, CARLETON ALEXANDER JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:CARLETON
Middle Name:ALEXANDER
Last Name:NELSON
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:1616 E WAVERLY DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60004-3446
Mailing Address - Country:US
Mailing Address - Phone:847-392-3286
Mailing Address - Fax:847-506-0176
Practice Address - Street 1:37 N GREELEY ST
Practice Address - Street 2:
Practice Address - City:PALATINE
Practice Address - State:IL
Practice Address - Zip Code:60067-5054
Practice Address - Country:US
Practice Address - Phone:847-358-1111
Practice Address - Fax:847-358-3020
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X, 1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered122300000XDental ProvidersDentist
Not Answered1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics