Provider Demographics
NPI:1528148616
Name:DIERS, NELSON R (DDS)
Entity type:Individual
Prefix:
First Name:NELSON
Middle Name:R
Last Name:DIERS
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 1:1251 NILLES RD
Mailing Address - Street 2:SUITE #14
Mailing Address - City:FAIRFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45014-7206
Mailing Address - Country:US
Mailing Address - Phone:513-829-4400
Mailing Address - Fax:513-829-7467
Practice Address - Street 1:1251 NILLES RD
Practice Address - Street 2:SUITE #14
Practice Address - City:FAIRFIELD
Practice Address - State:OH
Practice Address - Zip Code:45014-7206
Practice Address - Country:US
Practice Address - Phone:513-829-4400
Practice Address - Fax:513-829-7467
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2010-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300130691223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH30013069OtherOHIO DENTAL LICENSE