Peter S Nelson, D.D.S.

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

9095 Issued in AZ

Practice address

5750 W Thunderbird Rd Ste H850
Glendale, AZ 85306-4694

Phone

(602) 938-0880

Fax

(602) 547-0528

NPI assigned

Dec 25, 2009

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Sep 2, 2015 through Sep 2, 2027

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Peter S. Nelson, DDS, PLLC

  • Oral and Maxillofacial Surgery (Dentist)
  • Glendale, AZ
  • NPI 1760845978
  NPD (past) Authorized official
• Affiliated Oral & Maxillofacial Surgeons PC

  • Oral and Maxillofacial Surgery (Dentist)
  • Glendale, AZ
  • NPI 1013023928
  NPD (past)

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

{
    "created_epoch": "1261699200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712880000000",
    "number": "1508196437",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5750 W THUNDERBIRD RD STE H850",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853064694",
            "telephone_number": "402-990-3457"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5750 W THUNDERBIRD RD STE H850",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853064694",
            "telephone_number": "602-938-0880",
            "fax_number": "602-547-0528"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NELSON",
        "first_name": "PETER",
        "middle_name": "S",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-12-25",
        "last_updated": "2024-04-12",
        "certification_date": "2024-04-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "NY",
            "license": "AB3433531218",
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "AZ",
            "license": "9095",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nelson Family Dentistry, PC
• Anthony Dominic Nelson, PA-C
• Jacque Catalano Nelson, MOTR.L
• Julie Anne Nelson, RDN
• Kimberly Nelson, PA-C
• Michelle Nemeh
• Manisha Sandip Nerkar, MD
• John David Nerva, MD
• Emma Trudy Nettles, LAT, ATC
• Stephen G. Netzel, D.D.S.

• Oral and Maxillofacial Surgery (Dentist) in Glendale, AZ
• Providers in Glendale, AZ by specialty
• Oral and Maxillofacial Surgery (Dentist) in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.