Nicollet Dental

NPI #1003108895 in Minneapolis, Minnesota

Provider Information

NPI Number: 1003108895
Entity Type: Organization
Organization Name: Nicollet Dental
Primary Specialty: Dentist
Enumeration Date: May 11, 2011
Last Updated: May 11, 2011

Practice Location

Address: 6101 NICOLLET AVE. SO.
City: Minneapolis
State: Minnesota
ZIP Code: 55419
Phone: (612) 866-8550

Authorized Official

Name: DR. CASEY LEE NELSON, D.D.S.
Title: OWNER
Phone: (612) 866-8550

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X	Primary

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