Organization
MICHAEL S. NELSON
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PATRICIA L. WEBB (BUSINESS MANAGER)
(479) 521-4440
Entity
Organization
Contact information
Practice address
605 EUREKA AVE, SUITE C, BERRYVILLE, AR 72616-3839
(870) 423-4042
(870) 423-7173
Mailing address
605 EUREKA AVE, SUITE C, BERRYVILLE, AR 72616-3839
(870) 423-4042
(870) 423-7173
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1932119054
NPI #
AR
Enumeration date
05/31/2007
Last updated
08/22/2020
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