Provider Demographics
NPI:1124111620
Name:NELSON, RICHARD J (DDS)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:J
Last Name:NELSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 CUMBERLAND RD.
Mailing Address - Street 2:SUITE 103
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15237
Mailing Address - Country:US
Mailing Address - Phone:412-366-8118
Mailing Address - Fax:
Practice Address - Street 1:135 CUMBERLAND RD.
Practice Address - Street 2:SUITE 103
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15237
Practice Address - Country:US
Practice Address - Phone:412-366-8118
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS017447L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice