Provider Demographics
NPI:1194774109
Name:DR STEVEN F NIELSEN DDS PA
Entity type:Organization
Organization Name:DR STEVEN F NIELSEN DDS PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:HALF OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:F
Authorized Official - Last Name:NIELSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:208-357-7611
Mailing Address - Street 1:PO BOX 525
Mailing Address - Street 2:
Mailing Address - City:SHELLEY
Mailing Address - State:ID
Mailing Address - Zip Code:83274-0525
Mailing Address - Country:US
Mailing Address - Phone:208-357-7611
Mailing Address - Fax:208-357-1805
Practice Address - Street 1:371 W FIR ST
Practice Address - Street 2:
Practice Address - City:SHELLEY
Practice Address - State:ID
Practice Address - Zip Code:83274-1456
Practice Address - Country:US
Practice Address - Phone:208-357-7611
Practice Address - Fax:208-357-1805
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty