Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | D6700 | OR |
NPI | 1083600712 |
---|---|
Provider Name | Dr. Bc Nelson |
First Address | Stayton, OR 97383-1837 |
Second Address | Stayton, OR 97383-1837 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2005 |
Last Update Date | 08/07/2007 |