Doctor Name: | DR. GREGORY M NIELSEN |
NPI Number: | 1518949742 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | DDS |
License Number: | 2901014950 |
Business Practice Address: | 26111 Woodward Ave Huntington Woods, MI - 480701330 |
Business Phone Number: | 2485478833 |
Business Fax Number: | 2485478836 |
Mailing Address: | 26111 Woodward Ave, HUNTINGTON WOODS |
State: | MI |
Postal Code: | 480701330 |
Phone Number: | 2485478833 |
Fax Number: | 2485478836 |
NPI Enumeration Date: | 11/15/2005 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 204E00000X |
License Number: | 2901014950 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MI |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | Oral & Maxillofacial Surgery |
Taxonomy Specialization: | |
Taxonomy Definition: |