Provider Demographics
NPI:1215147871
Name:NELSON, DAREL ARVIN (DDS)
Entity type:Individual
Prefix:DR
First Name:DAREL
Middle Name:ARVIN
Last Name:NELSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:DAREL
Other - Middle Name:A
Other - Last Name:NELSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:AGENCY STREET
Mailing Address - Street 2:DENTAL CLINIC
Mailing Address - City:BOX ELDER
Mailing Address - State:MT
Mailing Address - Zip Code:59521-0000
Mailing Address - Country:US
Mailing Address - Phone:406-395-4406
Mailing Address - Fax:
Practice Address - Street 1:CHIPPEWA-CREE HEALTH CENTER AGENCY STREET
Practice Address - Street 2:DENTAL CLINIC DIVISION
Practice Address - City:BOX ELDER
Practice Address - State:MT
Practice Address - Zip Code:59521-0000
Practice Address - Country:US
Practice Address - Phone:406-395-4406
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT136699-99211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice