Provider Demographics
NPI:1780779801
Name:NELSON, TRENT (DMD)
Entity type:Individual
Prefix:
First Name:TRENT
Middle Name:
Last Name:NELSON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:657 LONE OAK RD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42003-4547
Mailing Address - Country:US
Mailing Address - Phone:270-442-5071
Mailing Address - Fax:270-442-5067
Practice Address - Street 1:657 LONE OAK RD
Practice Address - Street 2:SUITE 5
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-4547
Practice Address - Country:US
Practice Address - Phone:270-442-5071
Practice Address - Fax:270-442-5067
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY75001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice