Provider Demographics
NPI:1124863741
Name:NELSON, SHAUN (DDS)
Entity type:Individual
Prefix:
First Name:SHAUN
Middle Name:
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 1:3610 SUNRIDGE HEIGHTS WAY UNIT 3406
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-4682
Mailing Address - Country:US
Mailing Address - Phone:248-909-6609
Mailing Address - Fax:
Practice Address - Street 1:9771 S EASTERN AVE STE 100
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89183-6801
Practice Address - Country:US
Practice Address - Phone:702-616-9655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-26
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV80411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice