Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 1184 | AK |
N | 122300000X | Dentist | 2511 | WI |
NPI | 1003912916 |
---|---|
Provider Name | Dr. David Eugene Nelson |
First Address | Homer, AK 99603-7522 |
Second Address | Homer, AK 99603-7522 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/09/2006 |
Last Update Date | 02/02/2012 |