Provider Demographics
NPI:1285734020
Name:NELSON, DON (DDS , MSD)
Entity type:Individual
Prefix:
First Name:DON
Middle Name:
Last Name:NELSON
Suffix:
Gender:M
Credentials:DDS , MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 67
Mailing Address - Street 2:
Mailing Address - City:POPLAR
Mailing Address - State:MT
Mailing Address - Zip Code:59255-0067
Mailing Address - Country:US
Mailing Address - Phone:406-768-3491
Mailing Address - Fax:406-768-3423
Practice Address - Street 1:107 H STREET EAST
Practice Address - Street 2:
Practice Address - City:POPLAR
Practice Address - State:MT
Practice Address - Zip Code:59255
Practice Address - Country:US
Practice Address - Phone:406-768-3491
Practice Address - Fax:406-768-3423
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT19541223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT2210068Medicaid
WADE00004115OtherWA STATE BOARD
MT1954OtherMT. STATE BOARD
IDD-3081OtherIDAHO STATE BOARD