Provider Demographics
NPI:1922334473
Name:NELSON, EVELYN M (DMD)
Entity Type:Individual
Prefix:DR
First Name:EVELYN
Middle Name:M
Last Name:NELSON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 HUNTINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07060-2824
Mailing Address - Country:US
Mailing Address - Phone:908-757-5688
Mailing Address - Fax:
Practice Address - Street 1:425 HUNTINGTON AVE
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07060-2824
Practice Address - Country:US
Practice Address - Phone:908-757-5688
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-19
Last Update Date:2009-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY050039122300000X
NJ22DI101739700122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist