Provider Demographics
NPI:1003912916
Name:NELSON, DAVID EUGENE (DDS)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:EUGENE
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 1:1320 S GREEN BAY RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:WI
Mailing Address - Zip Code:53406-4402
Mailing Address - Country:US
Mailing Address - Phone:262-223-0280
Mailing Address - Fax:262-223-0281
Practice Address - Street 1:1320 S GREEN BAY RD
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:WI
Practice Address - Zip Code:53406-4402
Practice Address - Country:US
Practice Address - Phone:262-223-0280
Practice Address - Fax:262-223-0281
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2511122300000X
AK1184122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist