Provider Demographics
NPI:1902829633
Name:NELSON, DARRIN JOHN (DMD)
Entity Type:Individual
Prefix:DR
First Name:DARRIN
Middle Name:JOHN
Last Name:NELSON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:MR
Other - First Name:DARRIN
Other - Middle Name:JOHN
Other - Last Name:NELSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:6791 W HAPPY VALLEY RD STE 101
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85383-4865
Mailing Address - Country:US
Mailing Address - Phone:623-471-9030
Mailing Address - Fax:
Practice Address - Street 1:6791 W HAPPY VALLEY RD STE 101
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85383-4865
Practice Address - Country:US
Practice Address - Phone:623-471-9030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4796122300000X
OR4796122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist