Provider Demographics
NPI:1942500970
Name:NUNEZ, NELSON R (DMD)
Entity type:Individual
Prefix:DR
First Name:NELSON
Middle Name:R
Last Name:NUNEZ
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 860036
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55486-0036
Mailing Address - Country:US
Mailing Address - Phone:855-801-8941
Mailing Address - Fax:
Practice Address - Street 1:2640 E LEAGUE CITY PKWY
Practice Address - Street 2:108
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573-3368
Practice Address - Country:US
Practice Address - Phone:855-801-8941
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-25
Last Update Date:2016-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR28591223G0001X
TX308811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice