Provider Demographics
NPI:1336211408
Name:NELSON, SCOTT J (DDS)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:J
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 1:427 CENTERSTONE CT
Mailing Address - Street 2:
Mailing Address - City:ZEELAND
Mailing Address - State:MI
Mailing Address - Zip Code:49464-2247
Mailing Address - Country:US
Mailing Address - Phone:616-748-4100
Mailing Address - Fax:616-748-0608
Practice Address - Street 1:427 CENTERSTONE CT
Practice Address - Street 2:
Practice Address - City:ZEELAND
Practice Address - State:MI
Practice Address - Zip Code:49464-2247
Practice Address - Country:US
Practice Address - Phone:616-748-4100
Practice Address - Fax:616-748-0608
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2008-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI176341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice