# DR. MARK W NELSON

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1124043583
- **Gender:** Man
- **Credential:** D.D.S.

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 1570 | ND | Yes |

## Other

- **Enumeration date:** 07/13/2006
- **Last updated:** 10/09/2015

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 000812181 | UCCI | ND |
| 01 | — | 05072001 | BC/BS | ND |
| 05 | — | 1451441 | — | ND |