Provider Demographics
NPI:1366553299
Name:NELSON, MARTIN GILL (DDS INC)
Entity type:Individual
Prefix:
First Name:MARTIN
Middle Name:GILL
Last Name:NELSON
Suffix:
Gender:M
Credentials:DDS INC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 HILLTOP DRIVE
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96002
Mailing Address - Country:US
Mailing Address - Phone:530-222-5803
Mailing Address - Fax:530-222-3409
Practice Address - Street 1:2100 HILLTOP DRIVE
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002
Practice Address - Country:US
Practice Address - Phone:530-222-5803
Practice Address - Fax:530-222-3409
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14148122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist