# BRENT E. NELSEN DMD, LLC

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

## Provider details

- **NPI number:** 1396149183
- **Authorized official:** DR. BRENT EDWARD NELSEN DMD (OWNER)
- **Authorized official phone:** (316) 789-9999

## Contact information

- **Practice address:** 1120 N ROCK RD, DERBY, KS 67037-3584
- **Practice address phone:** (316) 789-9999
- **Practice address fax:** (316) 789-9296
- **Mailing address:** 1120 N ROCK RD, DERBY, KS 67037-3584
- **Mailing address phone:** (316) 789-9999
- **Mailing address fax:** (316) 789-9296

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 7193 | KS | Yes |

## Other

- **Enumeration date:** 10/22/2014
- **Last updated:** 10/22/2014