James Wayne Nelson, DDS

Individual provider Active NPI General Practice Dentistry · Rio, WI

NPI 1508970666 · NPPES record last updated Jul 8, 2007

Key facts

NPI
1508970666
Entity type
Individual (NPI type 1)
Primary specialty
General Practice Dentistry 1223G0001X
License
5001423-015 (WI)
Practice address
315 Union St.
Rio, WI 53960-0218
Phone
(920) 992-3500
Fax
(920) 992-5115
NPI assigned
Aug 18, 2006
Sex
Male
Sole proprietor
Yes

Organizations & group practices 1

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.

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
5001423-015WIMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
James W Nelson DDS, S.C. General Practice Past Accepting new patients

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 5001423-015 WI Yes

Addresses

Primary practice location

315 Union St.
Rio, WI 53960-0218

Mailing address

315 Union St.
P.O. Box 218
Rio, WI 53960-0218
Phone (920) 992-3500

Other identifiers

IdentifierTypeStateIssuer
33659700MedicaidWI

Other providers in Rio, WI

All providers in Rio, WI · General Practice Dentistry in Wisconsin

Sources for this page

Verify at the official NPI Registry.