Provider Demographics
NPI:1386922912
Name:NELSON, GEORGIANNE NICOLE (DDS)
Entity type:Individual
Prefix:DR
First Name:GEORGIANNE
Middle Name:NICOLE
Last Name:NELSON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1345 E UNIVERSITY AVE # 302
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50316-2461
Mailing Address - Country:US
Mailing Address - Phone:515-264-9022
Mailing Address - Fax:
Practice Address - Street 1:1345 E UNIVERSITY AVE # 302
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50316-2461
Practice Address - Country:US
Practice Address - Phone:515-264-9022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-01
Last Update Date:2011-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA08849122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist