Individual
DR. CONNER JERRY NIELSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
155 N FRESNO ST, FRESNO, CA 93701-2302
(559) 459-4182
Mailing address
11028 CAMPUS ST, LOMA LINDA, CA 92354-2705
(714) 788-6690
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
107665
CA
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
107665
CA
Other
Enumeration date
07/26/2022
Last updated
03/27/2023
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