Provider Demographics
NPI:1811918238
Name:NIELSEN, TERRY L (DDS)
Entity type:Individual
Prefix:DR
First Name:TERRY
Middle Name:L
Last Name:NIELSEN
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 1:4577 LEBLANC CT
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48116-4769
Mailing Address - Country:US
Mailing Address - Phone:810-229-8423
Mailing Address - Fax:
Practice Address - Street 1:40105 GRAND RIVER AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375-2170
Practice Address - Country:US
Practice Address - Phone:248-471-0345
Practice Address - Fax:248-471-0671
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI0101691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice