Provider Demographics
NPI:1215925151
Name:NELSON, SEAN K (DDS)
Entity type:Individual
Prefix:DR
First Name:SEAN
Middle Name:K
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 1:205 6TH PL NW
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:MN
Mailing Address - Zip Code:55912-3025
Mailing Address - Country:US
Mailing Address - Phone:507-433-9515
Mailing Address - Fax:507-434-0254
Practice Address - Street 1:205 6TH PL NW
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:MN
Practice Address - Zip Code:55912-3025
Practice Address - Country:US
Practice Address - Phone:507-433-9515
Practice Address - Fax:507-434-0254
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN113381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1035OtherHEALTH PARTNERS IDENTIFIE
MN124L8NEOtherBCBS IDENTIFIER