Nelson Henry, DDS, LLC

Primary specialty

DentistTaxonomy code 122300000X

License

016072 Issued in MO

Legal business name

NELSON HENRY, DDS, LLC

Practice address

3306 Emerald LN
Jefferson City, MO 65109-6877

Phone

(573) 634-2222

Fax

(573) 634-8812

NPI assigned

May 3, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Nelson Henry, DDS

Title

DDS

Phone

(573) 634-2222

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• West Edgewood Dental, Vanderveen Dental Doing business as

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

{
    "created_epoch": "1178150400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1093937518",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3306 EMERALD LN",
            "city": "JEFFERSON CITY",
            "state": "MO",
            "postal_code": "651096877",
            "telephone_number": "573-634-2222",
            "fax_number": "573-634-8812"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3306 EMERALD LN",
            "city": "JEFFERSON CITY",
            "state": "MO",
            "postal_code": "651096877",
            "telephone_number": "573-634-2222",
            "fax_number": "573-634-8812"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NELSON HENRY, DDS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-03",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "HENRY",
        "authorized_official_first_name": "NELSON",
        "authorized_official_title_or_position": "DDS",
        "authorized_official_telephone_number": "573-634-2222",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "MO",
            "license": "016072",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "113009",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "113013",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "West Edgewood Dental, Vanderveen Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Nathalie Tungesvik,DDS,PC
• Bethany Naughton, OTR-L
• Navigational Care
• Manav Nayyar, M.D.
• Kayla Neeper, DC
• Annie Marie Nelson, RD
• David Vernon Nelson, DPT
• Jordan Elizabeth Nelson, DMD
• Merideth Lee Nelson, MS CCC SLP
• Abigail Elizabeth Nepean, COTA/L

• Dentist in Jefferson City, MO
• Providers in Jefferson City, MO by specialty
• Dentist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.