Active NPI
Merrill D Nelson, DDS
- General Practice Dentistry
- Glencoe, MN
National Provider Identifier
1790863751
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 7739
- Practice address
- 1015 Greeley Ave
Glencoe, MN 55336 - Phone
- (320) 864-3129
- Fax
- (320) 864-4920
- NPI assigned
- Nov 1, 2006
- 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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 7739 | MN | Primary |
Addresses
Primary practice location
1015 Greeley Ave
Glencoe, MN 55336
Mailing address
1015 Greeley Ave
Glencoe, MN 55336
Phone (320) 864-3129
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 7739 | Other | MN | LIC # |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7739 | MN | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Forever Smiles, PLLC | Past | Accepting new patients |
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.
-
- Dental Clinic/Center
- Arlington, MN
- NPI 1952898660
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1162339200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1790863751",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1015 GREELEY AVE",
"city": "GLENCOE",
"state": "MN",
"postal_code": "55336",
"telephone_number": "320-864-3129",
"fax_number": "320-864-4920"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1015 GREELEY AVE",
"city": "GLENCOE",
"state": "MN",
"postal_code": "55336",
"telephone_number": "320-864-3129",
"fax_number": "320-864-4920"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NELSON",
"first_name": "MERRILL",
"middle_name": "D",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-11-01",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "MN",
"license": "7739",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LIC #",
"identifier": "7739",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Glencoe, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.