Individual
DR. JOHN MICHAEL NELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
3166 GOLANSKY BLVD, SUITE 101, WOODBRIDGE, VA 22192
(703) 730-2931
(703) 730-2484
Mailing address
3166 GOLANSKY BLVD, SUITE 101, WOODBRIDGE, VA 22192
(703) 730-2931
(703) 730-2484
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
7559
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
276957
ANTHEM BCBS
—
01
—
755992
UNITED CONCORDIA
—
Enumeration date
09/05/2006
Last updated
07/08/2007
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