Organization
MILLENNIUM DENTAL, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL S NELSON D.D.S. (DENTIST)
(479) 521-4440
Entity
Organization
Contact information
Practice address
2827 E MILLENNIUM PL STE 3, FAYETTEVILLE, AR 72703-6528
(479) 521-4440
(479) 521-4443
Mailing address
2827 E MILLENNIUM PL STE 3, FAYETTEVILLE, AR 72703-6528
(479) 521-4440
(479) 521-4443
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
AR3216
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1790011
UNITED CONCORDIA ID
AR
01
—
5T702
BLUE CROSS BLUE SHIELD ID
AR
01
—
AR3216
STATE LICENSE NUMBER
AR
Enumeration date
08/09/2006
Last updated
08/22/2020
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