Provider Demographics
NPI:1669446530
Name:NELSON, BRYAN P (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:P
Last Name:NELSON
Suffix:
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 1:6952 SECREST CT
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80007-7650
Mailing Address - Country:US
Mailing Address - Phone:303-460-1073
Mailing Address - Fax:303-431-6709
Practice Address - Street 1:8723 WADSWORTH BLVD
Practice Address - Street 2:
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80003-0921
Practice Address - Country:US
Practice Address - Phone:303-422-6752
Practice Address - Fax:303-431-6709
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO70521223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics