Individual
MICHAEL GENE NEILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
60TH DENTAL SQUADRON, 101 BODIN CIRCLE, TRAVIS AFB, CA 94535
(707) 423-7085
Mailing address
206 RED PHEASANT DR, VACAVILLE, CA 95687-7748
(503) 367-9417
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
D8635
OR
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
D8635
OR
Other
Enumeration date
05/08/2006
Last updated
11/19/2011
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