Provider Demographics
NPI:1780737254
Name:NELSON, DANIEL JOHN
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:JOHN
Last Name:NELSON
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:DANIEL
Other - Middle Name:JOHN
Other - Last Name:NELSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:697 N 1ST ST
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:MI
Mailing Address - Zip Code:48625-7726
Mailing Address - Country:US
Mailing Address - Phone:989-539-9712
Mailing Address - Fax:989-539-8330
Practice Address - Street 1:697 N 1ST ST
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:MI
Practice Address - Zip Code:48625-7726
Practice Address - Country:US
Practice Address - Phone:989-539-9712
Practice Address - Fax:989-539-8330
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010101661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice