Provider Demographics
NPI:1659427698
Name:NELSON, WILLIAM NEWMAN JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:NEWMAN
Last Name:NELSON
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:332 E JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:YAZOO CITY
Mailing Address - State:MS
Mailing Address - Zip Code:39194
Mailing Address - Country:US
Mailing Address - Phone:662-746-8140
Mailing Address - Fax:662-716-9160
Practice Address - Street 1:332 E JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:YAZOO CITY
Practice Address - State:MS
Practice Address - Zip Code:39194
Practice Address - Country:US
Practice Address - Phone:662-746-8140
Practice Address - Fax:662-716-9160
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1786771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00064611Medicaid