Jacy Craig Nelson, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DE00009342 Issued in WA

Practice address

14300 SE Petrovitsky Rd
Renton, WA 98058-8955

Phone

(253) 852-0206

Fax

(253) 852-6351

NPI assigned

Dec 23, 2005

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

Medicare fee-for-service enrollment

Enrolled in WA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Jacy C Nelson D.D.S., P.S.

  • Dentist
  • Renton, WA
  • NPI 1154878668
  NPD Authorized official

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

{
    "created_epoch": "1135296000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1773792000000",
    "number": "1225015977",
    "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": "253-852-0206",
            "fax_number": "253-852-6351"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NELSON",
        "first_name": "JACY",
        "middle_name": "CRAIG",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-12-23",
        "last_updated": "2026-03-18",
        "certification_date": "2026-03-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WA",
            "license": "DE00009342",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Neighborhood Cabulance
• Carla D Neiss, SLP
• Shamim Hashemi Nejad, MD
• Meghann Elizabeth Nelles-Dalstrom, MD
• Michele K Nelsen, MD
• Janet Nelson
• John W Nemanich, MD
• Lindsay Nemeyer
• Alysa Mai Goto Nemoto, DPT
• Homa Devi Neopaney

• General Practice Dentistry in Renton, WA
• Providers in Renton, WA by specialty
• General Practice Dentistry in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2026; 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.

Verify at the official NPI Registry.