Provider Demographics
NPI:1750304440
Name:NELSON, EDWARD P (DMD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:P
Last Name:NELSON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:709 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:OSTERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02655-1903
Mailing Address - Country:US
Mailing Address - Phone:508-428-3744
Mailing Address - Fax:508-428-8840
Practice Address - Street 1:709 MAIN ST
Practice Address - Street 2:
Practice Address - City:OSTERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02655-1903
Practice Address - Country:US
Practice Address - Phone:508-428-3744
Practice Address - Fax:508-428-8840
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA133391223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics