Individual
DR. MARK W NELSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
204 HIGHWAY 12 E, HETTINGER, ND 58639-9687
(701) 567-4302
(701) 567-4303
Mailing address
PO BOX 1193, HETTINGER, ND 58639-1193
(701) 567-4302
(701) 567-4303
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
1570
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000812181
UCCI
ND
01
—
05072001
BC/BS
ND
05
—
1451441
—
ND
Enumeration date
07/13/2006
Last updated
10/09/2015
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