Individual
MICHAEL NELSON
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Contact information
Practice address
13550 26TH AVE N, PLYMOUTH, MN 55441-3650
(952) 929-0641
Mailing address
5100 EDEN AVE, EDINA, MN 55436-2337
(952) 929-0641
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D12133
MN
Other
Enumeration date
10/21/2005
Last updated
07/08/2007
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