Provider Demographics
NPI:1821356841
Name:NELSON, KYLE (DDS, MS)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:
Last Name:NELSON
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1570 ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001-5192
Mailing Address - Country:US
Mailing Address - Phone:507-386-0288
Mailing Address - Fax:
Practice Address - Street 1:1570 ADAMS ST
Practice Address - Street 2:
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-5192
Practice Address - Country:US
Practice Address - Phone:507-386-0288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-27
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND131041223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics