Provider Demographics
NPI:1194587550
Name:ROBERT A NELSON DDS
Entity type:Organization
Organization Name:ROBERT A NELSON DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:740-353-1313
Mailing Address - Street 1:1425 OFFNERE ST
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45662-3505
Mailing Address - Country:US
Mailing Address - Phone:740-353-1313
Mailing Address - Fax:740-353-1234
Practice Address - Street 1:1425 OFFNERE ST
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662-3505
Practice Address - Country:US
Practice Address - Phone:740-353-1313
Practice Address - Fax:740-353-1234
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ROBERT A NELSON DDS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-01-30
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH6354654Medicaid