Individual
MICHAEL JOHN NELSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S
Contact information
Practice address
801 S LEE ST, SUITE A, FORT GIBSON, OK 74434-8710
(918) 478-4433
(918) 478-4066
Mailing address
PO BOX 1828, 801-A S. LEE, FORT GIBSON, OK 74434-1828
(918) 478-4433
(918) 478-4066
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
5080
OK
Other
Enumeration date
02/13/2007
Last updated
07/08/2007
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