Jacy C Nelson D.D.S., P.S.

Primary specialty

DentistTaxonomy code 122300000X

License

DE9342 Issued in WA

Legal business name

JACY C NELSON D.D.S., P.S.

Practice address

14300 SE Petrovitsky Rd
Renton, WA 98058-8955

Phone

(253) 852-0202

Fax

(253) 852-5361

NPI assigned

Sep 1, 2016

Organization subpart

No

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

Authorized official

Name

Dr. Jacy Craig Nelson, DDS, PSNPI 1225015977

Title

Owner

Phone

(253) 852-0206

Specialties & licenses 1

Addresses

Part of

Jacy C Nelson DDS PS

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jacy Craig Nelson, D.D.S.

  • General Practice Dentistry
  • Renton, WA
  • NPI 1225015977
  NPD Authorized official

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

{
    "created_epoch": "1472688000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1778457600000",
    "number": "1154878668",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14300 SE PETROVITSKY RD",
            "city": "RENTON",
            "state": "WA",
            "postal_code": "980588955",
            "telephone_number": "253-852-0206",
            "fax_number": "253-852-5361"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14300 SE PETROVITSKY RD",
            "city": "RENTON",
            "state": "WA",
            "postal_code": "980588955",
            "telephone_number": "253-852-0202",
            "fax_number": "253-852-5361"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACY C NELSON D.D.S., P.S.",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-09-01",
        "last_updated": "2026-05-11",
        "certification_date": "2026-05-11",
        "status": "A",
        "authorized_official_last_name": "NELSON",
        "authorized_official_first_name": "JACY",
        "authorized_official_middle_name": "CRAIG",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "253-852-0206",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS, PS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "WA",
            "license": "DE9342",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jelani Leif Jackson, MSW, LICSW
• Breana Jacobs
• Murray Jacobs
• Joshua William Jacobson, PT
• Jacqueline R. Buckley, LLC
• Jade Chiropractic and Wellness Center
• Hannah Jaggers, MD
• Deega Jama, RN
• James Hu, DMD, PLLC
• James N McKenna DDS.

• Dentist in Renton, WA
• Providers in Renton, WA by specialty
• Dentist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2026; 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.