Individual
DR. JED CODY NIELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
10123 LAKE CREEK PKWY, BUILDING 2, AUSTIN, TX 78729-1756
(512) 250-8101
(512) 258-7154
Mailing address
10123 LAKE CREEK PKWY, BUILDING 2, AUSTIN, TX 78729-1756
(512) 250-8101
(512) 258-7154
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
Primary
29379
TX
1223G0001X
General Practice Dentistry
29379
TX
1223G0001X
General Practice Dentistry
7543
AZ
Other
Enumeration date
07/14/2008
Last updated
01/07/2014
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