Provider Demographics
NPI:1679708325
Name:NELSON, RAECHEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:RAECHEL
Middle Name:
Last Name:NELSON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3409 W 12600 S
Mailing Address - Street 2:SUITE #220
Mailing Address - City:RIVERTON
Mailing Address - State:UT
Mailing Address - Zip Code:84065-7260
Mailing Address - Country:US
Mailing Address - Phone:801-542-0267
Mailing Address - Fax:801-542-0629
Practice Address - Street 1:3409 W 12600 S
Practice Address - Street 2:SUITE #220
Practice Address - City:RIVERTON
Practice Address - State:UT
Practice Address - Zip Code:84065-7260
Practice Address - Country:US
Practice Address - Phone:801-542-0267
Practice Address - Fax:801-542-0629
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-26
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7418970-99221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice