Provider Demographics
NPI:1811900863
Name:NELSON, KIRK ALAN (DDS)
Entity type:Individual
Prefix:DR
First Name:KIRK
Middle Name:ALAN
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 1:1404 E 10TH ST
Mailing Address - Street 2:
Mailing Address - City:ATLANTIC
Mailing Address - State:IA
Mailing Address - Zip Code:50022-1955
Mailing Address - Country:US
Mailing Address - Phone:712-243-5270
Mailing Address - Fax:712-243-1723
Practice Address - Street 1:1404 E 10TH ST
Practice Address - Street 2:
Practice Address - City:ATLANTIC
Practice Address - State:IA
Practice Address - Zip Code:50022-1955
Practice Address - Country:US
Practice Address - Phone:712-243-5270
Practice Address - Fax:712-243-1723
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA69021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice