# JACY C NELSON D.D.S., P.S.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1154878668
- **Authorized official:** DR. JACY CRAIG NELSON DDS, PS (OWNER)
- **Authorized official phone:** (253) 852-0206

## Contact information

- **Practice address:** 14300 SE PETROVITSKY RD, RENTON, WA 98058-8955
- **Practice address phone:** (253) 852-0202
- **Practice address fax:** (253) 852-5361
- **Mailing address:** 14300 SE PETROVITSKY RD, RENTON, WA 98058-8955
- **Mailing address phone:** (253) 852-0206
- **Mailing address fax:** (253) 852-5361

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | DE9342 | WA | Yes |

## Other

- **Enumeration date:** 09/01/2016
- **Last updated:** 05/11/2026