Provider Demographics
NPI:1306961040
Name:NEILSON, JOHN RICK (DDS, MS)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:RICK
Last Name:NEILSON
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1909 N GREEN VALLEY PKWY STE A
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-8353
Mailing Address - Country:US
Mailing Address - Phone:702-897-1611
Mailing Address - Fax:702-897-1396
Practice Address - Street 1:1909 N GREEN VALLEY PKWY STE A
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-8353
Practice Address - Country:US
Practice Address - Phone:702-897-1611
Practice Address - Fax:702-897-1396
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV21061223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics