Provider Demographics
NPI:1659308542
Name:DANIELSON, NILS ELDEN (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:NILS
Middle Name:ELDEN
Last Name:DANIELSON
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3138 PRIMROSE LN
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-3214
Mailing Address - Country:US
Mailing Address - Phone:248-217-8923
Mailing Address - Fax:
Practice Address - Street 1:3138 PRIMROSE LN
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-3214
Practice Address - Country:US
Practice Address - Phone:248-217-8923
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-27
Last Update Date:2013-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010188821223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics