Individual
DR. GREGORY WAYNE NELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
21410 136TH AVE NORTH SUITE #109, ROGERS, MN 55374
(763) 428-2217
(763) 428-8586
Mailing address
21410 136TH AVE NORTH SUITE #109, ROGERS, MN 55374
(763) 428-2217
(763) 428-8586
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D9395
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
46466NE
BCBS-MN
MN
Enumeration date
11/13/2006
Last updated
07/02/2019
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