Provider Demographics
NPI:1811032162
Name:JAMES W NELSON DDS, S.C.
Entity Type:Organization
Organization Name:JAMES W NELSON DDS, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:920-992-3500
Mailing Address - Street 1:P.O. BOX 218
Mailing Address - Street 2:315 UNION ST
Mailing Address - City:RIO
Mailing Address - State:WI
Mailing Address - Zip Code:53960-0218
Mailing Address - Country:US
Mailing Address - Phone:920-992-3500
Mailing Address - Fax:920-992-5115
Practice Address - Street 1:315 UNION ST.
Practice Address - Street 2:
Practice Address - City:RIO
Practice Address - State:WI
Practice Address - Zip Code:53960-0218
Practice Address - Country:US
Practice Address - Phone:920-992-3500
Practice Address - Fax:920-992-5115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5001423-0151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33659700Medicaid