1386273449 NPI number — DR. NICHOLAS THOMAS NELSON DDS

Table of content: DR. NICHOLAS THOMAS NELSON DDS (NPI 1386273449)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386273449 NPI number — DR. NICHOLAS THOMAS NELSON DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NELSON
Provider First Name:
NICHOLAS
Provider Middle Name:
THOMAS
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:
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:
1386273449
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/26/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
374 MDG, UNIT 5071
Provider Second Line Business Mailing Address:
YOKOTA AB
Provider Business Mailing Address City Name:
TOKYO
Provider Business Mailing Address State Name:
JAPAN
Provider Business Mailing Address Postal Code:
APO AP 96328
Provider Business Mailing Address Country Code:
JP
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
374 MDG, UNIT 5071
Provider Second Line Business Practice Location Address:
YOKOTA AB
Provider Business Practice Location Address City Name:
TOKYO
Provider Business Practice Location Address State Name:
JAPAN
Provider Business Practice Location Address Postal Code:
APO AP 96328
Provider Business Practice Location Address Country Code:
JP
Provider Business Practice Location Address Telephone Number:
315-225-7508
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/02/2020

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: 171000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223G0001X , with the licence number: 36769 , 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)





Copyright © 2007-2025 www.npivalidator.com