Individual
DR. MARK L NELSON
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
D.D.S
Contact information
Practice address
1551 RENAISSANCE TOWNE DR, SUITE 540, BOUNTIFUL, UT 84010-7667
(801) 295-8322
(801) 295-7694
Mailing address
1551 RENAISSANCE TOWNE DR, SUITE 540, BOUNTIFUL, UT 84010-7667
(801) 295-8322
(801) 295-7694
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
141802
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
562460
UNITED CONCORDIA
UT
01
—
870542081
TAX ID FOR MISC INSURANCE
UT
Enumeration date
03/27/2006
Last updated
07/08/2007
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