NPI 1003108895

Nicollet Dental

Organisation Dentist Minneapolis, MN

Practice location

Address: 6101 Nicollet Ave. So., Minneapolis, MN 55419
Phone: (612) 866-8550
Fax: (612) 866-9453

Authorised official

Name: Casey Lee Nelson
Title: Owner
Phone: (612) 866-8550

Registered specialties

Dentist Primary

Dental Providers Taxonomy 122300000X Licence D12104 (MN)

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Registry record

NPI: 1003108895
Entity type: Organization
NPI issued: 11 May 2011
Record last updated: 11 May 2011

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.