Mark W Nelson, D.D.S. – General Practice Dentistry

Key facts

NPI: 1124043583
Entity type: Individual (NPI type 1)
Primary specialty: General Practice Dentistry 1223G0001X
License: 1570 (ND)
Practice address: 204 Highway 12 E
Hettinger, ND 58639-9687
Phone: (701) 567-4302
Fax: (701) 567-4303
NPI assigned: Jul 13, 2006
Sex: Male
Sole proprietor: Yes

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hettinger Family Dental, P.C. Dental Clinic/Center · Hettinger, ND · NPI 1851001168

NPD (past)

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): No

State licenses

License	State	Type	Specialty
1570	ND	MD	Speech-Language Pathologist

Practice roles

Organization	Specialty	Status	New patients
Hettinger Family Dental, P.C.		Past since Dec 6, 2022	Accepting new patients

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
General Practice Dentistry	1223G0001X	1570	ND	Yes

Addresses

Primary practice location

204 Highway 12 E
Hettinger, ND 58639-9687

Mailing address

PO Box 1193
Hettinger, ND 58639-1193
Phone (701) 567-4302

Other identifiers

Identifier	Type	State	Issuer
000812181	Other	ND	UCCI
1451441	Medicaid	ND
05072001	Other	ND	BC/BS

Other providers in Hettinger, ND

All providers in Hettinger, ND · General Practice Dentistry in North Dakota

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 9, 2015. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.