Provider Demographics
NPI:1316948136
Name:KRUM, NELSON CHARLES JR (DDS)
Entity type:Individual
Prefix:DR
First Name:NELSON
Middle Name:CHARLES
Last Name:KRUM
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5050 N ACADEMY BLVD
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918
Mailing Address - Country:US
Mailing Address - Phone:719-260-6093
Mailing Address - Fax:719-260-2339
Practice Address - Street 1:WAKINS BLDG. 125 MIDDLE RD. GUALO RAI
Practice Address - Street 2:
Practice Address - City:SAIPAN
Practice Address - State:MP
Practice Address - Zip Code:96950
Practice Address - Country:US
Practice Address - Phone:670-234-4040
Practice Address - Fax:670-488-1044
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO44991223G0001X
MP1211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice