Provider Demographics
NPI:1245338169
Name:NELSON, JAMES D JR (DDS)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:D
Last Name:NELSON
Suffix:JR
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 1:721 N CASCADE AVE
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80903-3211
Mailing Address - Country:US
Mailing Address - Phone:719-632-5756
Mailing Address - Fax:719-632-0120
Practice Address - Street 1:721 N CASCADE AVE
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-3211
Practice Address - Country:US
Practice Address - Phone:719-632-5756
Practice Address - Fax:719-632-0120
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO04071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice