Provider Demographics
NPI:1609020684
Name:MICHAEL F NELSON DDS PC
Entity Type:Organization
Organization Name:MICHAEL F NELSON DDS PC
Other - Org Name:NELSON ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:FREDERIC
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:702-433-0070
Mailing Address - Street 1:6169 S RAINBOW BLVD STE 105
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89118-3231
Mailing Address - Country:US
Mailing Address - Phone:702-433-0070
Mailing Address - Fax:702-876-3762
Practice Address - Street 1:6169 S RAINBOW BLVD STE 105
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118-3231
Practice Address - Country:US
Practice Address - Phone:702-433-0070
Practice Address - Fax:702-876-3762
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-04
Last Update Date:2008-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVS6471223P0221X
NVS383C1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1558385617OtherINDIVIDUAL NPI NUMBER