Active NPI
Shaun Nelson, DDS
- General Practice Dentistry
- Las Vegas, NV
National Provider Identifier
1124863741
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 8041
- Practice address
- 9771 S Eastern Ave Ste 100
Las Vegas, NV 89183-6801 - Phone
- (702) 616-9655
- NPI assigned
- Jun 26, 2024
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 8041 | NV | Primary |
Addresses
Primary practice location
9771 S Eastern Ave Ste 100
Las Vegas, NV 89183-6801
Mailing address
3610 Sunridge Heights Way Unit 3406
Henderson, NV 89052-4682
Phone (248) 909-6609
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NV
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240925003885 | NV | Order and Referring Only - Dentist | 4688115082 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8041 | NV | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1719360000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1719360000000",
"number": "1124863741",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3610 SUNRIDGE HEIGHTS WAY UNIT 3406",
"city": "HENDERSON",
"state": "NV",
"postal_code": "890524682",
"telephone_number": "248-909-6609"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9771 S EASTERN AVE STE 100",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891836801",
"telephone_number": "702-616-9655"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NELSON",
"first_name": "SHAUN",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2024-06-26",
"last_updated": "2024-06-26",
"certification_date": "2024-06-26",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "NV",
"license": "8041",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Las Vegas, NV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.