Provider Demographics
NPI:1588097331
Name:NELSON, CATHERINE ELIZABETH (DDS)
Entity type:Individual
Prefix:DR
First Name:CATHERINE
Middle Name:ELIZABETH
Last Name:NELSON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:CATHERINE
Other - Middle Name:ELIZABETH
Other - Last Name:ADAMSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:5917 STADIUM DR
Mailing Address - Street 2:APT 3B
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49009-3017
Mailing Address - Country:US
Mailing Address - Phone:231-878-2778
Mailing Address - Fax:
Practice Address - Street 1:5917 STADIUM DR
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009-3017
Practice Address - Country:US
Practice Address - Phone:269-372-1042
Practice Address - Fax:269-372-9962
Is Sole Proprietor?:No
Enumeration Date:2013-08-15
Last Update Date:2016-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901021066122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist