Provider Demographics
NPI:1205879160
Name:NELSON, RODNEY (DDS)
Entity type:Individual
Prefix:DR
First Name:RODNEY
Middle Name:
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 1:2606 WILDWOOD PL
Mailing Address - Street 2:
Mailing Address - City:DUNCAN
Mailing Address - State:OK
Mailing Address - Zip Code:73533-1805
Mailing Address - Country:US
Mailing Address - Phone:580-252-2049
Mailing Address - Fax:
Practice Address - Street 1:1501 BROOKWOOD AVE
Practice Address - Street 2:SUITE F
Practice Address - City:DUNCAN
Practice Address - State:OK
Practice Address - Zip Code:73533-1358
Practice Address - Country:US
Practice Address - Phone:580-252-2111
Practice Address - Fax:580-252-2111
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4-44841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice