Provider Demographics
NPI:1386601805
Name:JOO, NELSON SUNG (DMD)
Entity type:Individual
Prefix:DR
First Name:NELSON
Middle Name:SUNG
Last Name:JOO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2222 S FRASER ST
Mailing Address - Street 2:UNIT 3
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-4509
Mailing Address - Country:US
Mailing Address - Phone:303-671-0305
Mailing Address - Fax:303-369-6627
Practice Address - Street 1:2222 S FRASER ST
Practice Address - Street 2:UNIT 3
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-4509
Practice Address - Country:US
Practice Address - Phone:303-671-0305
Practice Address - Fax:303-369-6627
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1058631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO02586303Medicaid