Provider Demographics
NPI:1821467382
Name:NELSON, KEETS J (RDH)
Entity Type:Individual
Prefix:
First Name:KEETS
Middle Name:J
Last Name:NELSON
Suffix:
Gender:M
Credentials:RDH
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:J
Other - Last Name:NELSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3915 NE RODNEY AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97212
Mailing Address - Country:US
Mailing Address - Phone:208-720-7547
Mailing Address - Fax:
Practice Address - Street 1:10535 NE GLISAN ST SUITE 301
Practice Address - Street 2:DENTAL CARE TODAY
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97220
Practice Address - Country:US
Practice Address - Phone:503-444-2824
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-15
Last Update Date:2015-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH6761124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist