1598929143 NPI number — DR. JED CODY NIELSON DDS

Table of content: (NPI 1528699428)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598929143 NPI number — DR. JED CODY NIELSON DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NIELSON
Provider First Name:
JED
Provider Middle Name:
CODY
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
NIELSON
Provider Other First Name:
J
Provider Other Middle Name:
CODY
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1598929143
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/07/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10123 LAKE CREEK PKWY
Provider Second Line Business Mailing Address:
BUILDING 2
Provider Business Mailing Address City Name:
AUSTIN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78729-1756
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-250-8101
Provider Business Mailing Address Fax Number:
512-258-7154

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10123 LAKE CREEK PKWY
Provider Second Line Business Practice Location Address:
BUILDING 2
Provider Business Practice Location Address City Name:
AUSTIN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78729-1756
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-250-8101
Provider Business Practice Location Address Fax Number:
512-258-7154
Provider Enumeration Date:
07/14/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  7543 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223G0001X , with the licence number: 29379 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223E0200X , with the licence number: 29379 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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