Individual
DR. BRENT E NELSEN
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
1120 N ROCK RD, STE 100, DERBY, KS 67037
(316) 789-9999
(316) 789-9296
Mailing address
1120 N ROCK RD, STE 100, DERBY, KS 67037
(316) 789-9999
(316) 789-9296
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
7193
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
551227
UNITED CONCORDIA
—
Enumeration date
02/14/2006
Last updated
07/08/2007
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