Basic Information
| Provider Information | |||||||||
| NPI: | 1124333745 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NELSON | ||||||||
| FirstName: | DOUGLAS | ||||||||
| MiddleName: | JAMES | ||||||||
| NamePrefix: | DR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | P.O. BOX 2302 | ||||||||
| Address2: | |||||||||
| City: | DEER PARK | ||||||||
| State: | WA | ||||||||
| PostalCode: | 990062302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5092767787 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 11919 W. SPRAGUE AVE | ||||||||
| Address2: | |||||||||
| City: | AIRWAY HEIGHTS | ||||||||
| State: | WA | ||||||||
| PostalCode: | 990011899 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5092446840 | ||||||||
| FaxNumber: | 5092446830 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/09/2010 | ||||||||
| LastUpdateDate: | 08/09/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | 4585 | WA | Y | Dental Providers | Dentist |
No ID Information.