Active NPI
Brandon Lars Nielson, DMD
- Dentist
- Windsor, CO
National Provider Identifier
1366736357
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 10451
- Practice address
- 1297 Main St.
Suite3
Windsor, CO 80550 - Phone
- (970) 686-7775
- Fax
- (970) 686-5892
- NPI assigned
- Jun 7, 2011
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | 10451 | CO | Primary |
Addresses
Primary practice location
1297 Main St.
Suite3
Windsor, CO 80550
Mailing address
1297 Main St.
Suite3
Windsor, CO 80550
Phone (970) 686-7775
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CO
- 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 |
|---|---|---|---|---|
| I20161206000153 | CO | Order and Referring Only - Dentist | 9133409345 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10451 | CO | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1307404800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1446595200000",
"number": "1366736357",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1297 MAIN ST.",
"address_2": "SUITE3",
"city": "WINDSOR",
"state": "CO",
"postal_code": "80550",
"telephone_number": "970-686-7775",
"fax_number": "970-686-5892"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1297 MAIN ST.",
"address_2": "SUITE3",
"city": "WINDSOR",
"state": "CO",
"postal_code": "80550",
"telephone_number": "970-686-7775",
"fax_number": "970-686-5892"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NIELSON",
"first_name": "BRANDON",
"middle_name": "LARS",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-06-07",
"last_updated": "2015-11-04",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CO",
"license": "10451",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Windsor, CO
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2015; 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.