Jon Gregorie Nelson, D.D.S

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

WI 3898 Issued in WI

Practice address

418 23Rd Ave E
Superior, WI 54880-3707

Phone

(715) 398-3239

Fax

(715) 398-5799

NPI assigned

Nov 28, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1164672000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617062400000",
    "number": "1003982406",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "418 23RD AVE E",
            "city": "SUPERIOR",
            "state": "WI",
            "postal_code": "548803707",
            "telephone_number": "715-398-3239",
            "fax_number": "715-398-5799"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "418 23RD AVE E",
            "city": "SUPERIOR",
            "state": "WI",
            "postal_code": "548803707",
            "telephone_number": "715-398-3239",
            "fax_number": "715-398-5799"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NELSON",
        "first_name": "JON",
        "middle_name": "GREGORIE",
        "name_prefix": "Dr.",
        "credential": "D.D.S",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-28",
        "last_updated": "2021-03-30",
        "certification_date": "2021-03-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WI",
            "license": "WI 3898",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "33679400",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA",
            "identifier": "437434",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "WI 3898",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS MN IDENTIFIER",
            "identifier": "06508NE",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Dawn Moulton, RPT
• Nbo Dental, LLC
• Neal B O'Shaughnessy DDS LTD
• Adele Alyse Negash, CCC/SLP
• Andrea Nelson, MSW, LCSW
• Barbara M Nett
• Neve Inc
• Tammy Newberry
• Karen Wyse Niedermier, APRN, CNP
• Deborah Ann Noble-Olson, MACCCSLP

• General Practice Dentistry in Superior, WI
• Providers in Superior, WI by specialty
• General Practice Dentistry in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.