Provider Demographics
NPI:1629964804
Name:GWINN, NELSON JONATHAN (DMD)
Entity type:Individual
Prefix:DR
First Name:NELSON
Middle Name:JONATHAN
Last Name:GWINN
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 1:200 GROVE PARK LN STE 610
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36305-5919
Mailing Address - Country:US
Mailing Address - Phone:334-699-7777
Mailing Address - Fax:334-699-7778
Practice Address - Street 1:200 GROVE PARK LN STE 610
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36305-5919
Practice Address - Country:US
Practice Address - Phone:334-699-7777
Practice Address - Fax:334-699-7778
Is Sole Proprietor?:No
Enumeration Date:2025-06-16
Last Update Date:2025-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL74591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice