Provider Demographics
NPI:1396914685
Name:MICHAEL J NELSON D.D.S., PA
Entity type:Organization
Organization Name:MICHAEL J NELSON D.D.S., PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:952-920-4060
Mailing Address - Street 1:8001 HIGHWAY 7
Mailing Address - Street 2:#300
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55426-3942
Mailing Address - Country:US
Mailing Address - Phone:952-920-4060
Mailing Address - Fax:952-285-2960
Practice Address - Street 1:8001 HIGHWAY 7
Practice Address - Street 2:#300
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55426-3942
Practice Address - Country:US
Practice Address - Phone:952-920-4060
Practice Address - Fax:952-285-2960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-21
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND12133122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty