Provider Demographics
NPI:1922411438
Name:NELSON, TRICIA ROSE (DDS)
Entity Type:Individual
Prefix:DR
First Name:TRICIA
Middle Name:ROSE
Last Name:NELSON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2717 EKKO AVE
Mailing Address - Street 2:
Mailing Address - City:ALBERT LEA
Mailing Address - State:MN
Mailing Address - Zip Code:56007-2070
Mailing Address - Country:US
Mailing Address - Phone:507-373-5968
Mailing Address - Fax:507-373-8410
Practice Address - Street 1:2717 EKKO AVE
Practice Address - Street 2:
Practice Address - City:ALBERT LEA
Practice Address - State:MN
Practice Address - Zip Code:56007-2070
Practice Address - Country:US
Practice Address - Phone:507-373-5968
Practice Address - Fax:507-373-8410
Is Sole Proprietor?:No
Enumeration Date:2014-06-03
Last Update Date:2016-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND133821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice