Individual
DR. JON GREGORIE NELSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S
Contact information
Practice address
418 23RD AVE E, SUPERIOR, WI 54880-3707
(715) 398-3239
(715) 398-5799
Mailing address
418 23RD AVE E, SUPERIOR, WI 54880-3707
(715) 398-3239
(715) 398-5799
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
WI 3898
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
06508NE
BCBS MN IDENTIFIER
MN
05
—
33679400
—
WI
01
—
437434
UNITED CONCORDIA
WI
01
—
WI 3898
LICENSE
WI
Enumeration date
11/28/2006
Last updated
03/30/2021
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