Provider Demographics
NPI:1972563732
Name:NELSON, EMORY RUSSELL (DDS)
Entity Type:Individual
Prefix:DR
First Name:EMORY
Middle Name:RUSSELL
Last Name:NELSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2812 BRIAR CRK
Mailing Address - Street 2:
Mailing Address - City:CHICKASHA
Mailing Address - State:OK
Mailing Address - Zip Code:73018-7368
Mailing Address - Country:US
Mailing Address - Phone:405-222-1487
Mailing Address - Fax:405-222-1487
Practice Address - Street 1:5700 ARNOLD ST
Practice Address - Street 2:
Practice Address - City:TINKER AFB
Practice Address - State:OK
Practice Address - Zip Code:73145-8105
Practice Address - Country:US
Practice Address - Phone:405-736-2113
Practice Address - Fax:405-734-3008
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-01-96661223G0001X
VA04010045611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1223G0001XDental ProvidersDentistGeneral Practice