Provider Demographics
NPI:1316964018
Name:NIELSON, DONALD CLARENCE (DDS)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:CLARENCE
Last Name:NIELSON
Suffix:
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 1:16500 INDIAN CREEK PKWY
Mailing Address - Street 2:STE 100
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66062-1370
Mailing Address - Country:US
Mailing Address - Phone:913-829-8700
Mailing Address - Fax:913-829-8703
Practice Address - Street 1:16500 INDIAN CREEK PKWY
Practice Address - Street 2:STE 100
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66062-1370
Practice Address - Country:US
Practice Address - Phone:913-829-8700
Practice Address - Fax:913-829-8703
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSKS51191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice