Individual
DR. CRAIG LEE NELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
405 UNION ST, LAGRANGE, IN 46761-2234
(260) 463-3123
Mailing address
405 UNION ST, LAGRANGE, IN 46761-2234
(260) 463-3123
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
12006413A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100159780A
—
IN
Enumeration date
05/14/2007
Last updated
03/14/2019
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