1598753493 NPI number — NELSON FAMILY DENTAL, PLLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598753493 NPI number — NELSON FAMILY DENTAL, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NELSON FAMILY DENTAL, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1598753493
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
205 6TH PL NW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AUSTIN
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55912-3025
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
507-433-9515
Provider Business Mailing Address Fax Number:
507-434-0254

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
205 6TH PL NW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AUSTIN
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55912-3025
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
507-433-9515
Provider Business Practice Location Address Fax Number:
507-434-0254
Provider Enumeration Date:
10/13/2005

Additional Information

Authorized Official

Authorized Official Last Name:
NELSON
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
H.
Authorized Official Title or Position:
PARTNER
Authorized Official Telephone Number:
507-433-9515

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  7583 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 124L8NE . This is a "BCBS IDENTIFIER" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 1035 . This is a "HEALTH PARTNERS IDENTIFIE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com