Individual
DR. MICHAEL S NELSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
1122 W TRIMBLE AVE STE A, BERRYVILLE, AR 72616-5248
(870) 423-4042
(870) 423-7173
Mailing address
PO BOX 385, BERRYVILLE, AR 72616-0385
(870) 423-4042
(870) 423-7173
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
AR3216
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1653236
UNITED CONCORDIA I.D.
AR
01
—
5T702
BLUE CROSS BLUE SHIELD ID
AR
01
—
AR3216
STATE LICENSE I.D.
AR
Enumeration date
08/09/2006
Last updated
02/01/2022
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