Kevin Ted Nelson, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DE60690890 Issued in WA

Practice address

775 E Holland Ave Ste 201
Spokane, WA 99218-5016

Phone

(509) 464-2391

Fax

(509) 232-0555

NPI assigned

Jul 9, 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

Medicare enrollment (NPD)

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.

• Braun & Jarvis Family Dentistry, PS

  • General Practice Dentistry
  • Spokane, WA
  • NPI 1710031778
  NPD (past)
• New Health Programs Association

  dba NEW Health Lake Spokane Dental

  • Federally Qualified Health Center (FQHC)
  • Nine Mile Falls, WA
  • NPI 1235455932
  NPD (past)

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

{
    "created_epoch": "1247097600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1732492800000",
    "number": "1669601886",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "775 E HOLLAND AVE STE 201",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992185016",
            "telephone_number": "509-464-2391",
            "fax_number": "509-232-0555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "775 E HOLLAND AVE STE 201",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992185016",
            "telephone_number": "509-464-2391",
            "fax_number": "509-232-0555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NELSON",
        "first_name": "KEVIN",
        "middle_name": "TED",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-07-09",
        "last_updated": "2024-11-25",
        "certification_date": "2024-11-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MO",
            "license": "2009015337",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WA",
            "license": "DE60690890",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jane Nelson
• Jeffrey Edward Nelson, CRNA
• Jordan Nelson
• Katharine Ann Nelson, CERTIFIED PEER
• Katie Nelson
• Linda Colleen Nelson, PHARMD
• Lindsey B Nelson, SURGICAL ASST
• Madison Bailey Nelson, ARNP
• Martha Nelson, MSW
• Mary Pat Nelson, PMHNP-BC

• General Practice Dentistry in Spokane, WA
• Providers in Spokane, 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 Nov 25, 2024; 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.