Provider Demographics
NPI:1972551349
Name:NIELSEN, GERALD A, (DDS)
Entity type:Individual
Prefix:DR
First Name:GERALD
Middle Name:A,
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 1:620 N EMERSON AVE
Mailing Address - Street 2:
Mailing Address - City:WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98801-6619
Mailing Address - Country:US
Mailing Address - Phone:509-662-6269
Mailing Address - Fax:509-665-9479
Practice Address - Street 1:620 N EMERSON AVE
Practice Address - Street 2:SUITE #304
Practice Address - City:WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98801-6619
Practice Address - Country:US
Practice Address - Phone:509-662-6269
Practice Address - Fax:509-665-9479
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000034851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice