Provider Demographics
NPI:1922095983
Name:NELSON, RICKY DEAN (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:RICKY
Middle Name:DEAN
Last Name:NELSON
Suffix:
Gender:M
Credentials:DDS, MS
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Mailing Address - Street 1:974 73RD ST
Mailing Address - Street 2:SUITE 18
Mailing Address - City:WINDSOR HEIGHTS
Mailing Address - State:IA
Mailing Address - Zip Code:50312-1024
Mailing Address - Country:US
Mailing Address - Phone:515-223-0602
Mailing Address - Fax:515-223-7346
Practice Address - Street 1:974 73RD ST
Practice Address - Street 2:SUITE 18
Practice Address - City:WINDSOR HEIGHTS
Practice Address - State:IA
Practice Address - Zip Code:50312-1024
Practice Address - Country:US
Practice Address - Phone:515-223-0602
Practice Address - Fax:515-223-7346
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IA069111223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics