Individual
KIP NIELSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
17061 N AVENUE OF THE ARTS, STE 101, SUPRISE, AZ 85378
(623) 246-5025
Mailing address
3658 E ELMWOOD ST, MESA, AZ 85205-5165
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D009895
AZ
122300000X
Dentist
DE60590085
WA
Other
Enumeration date
08/12/2015
Last updated
02/18/2022
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