Provider Demographics
NPI:1205912532
Name:NIELSEN, STEVEN DWAYNE (DDS)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:DWAYNE
Last Name:NIELSEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1350 BOYSON ROAD
Mailing Address - Street 2:BLDG A
Mailing Address - City:HIAWATHA
Mailing Address - State:IA
Mailing Address - Zip Code:52233
Mailing Address - Country:US
Mailing Address - Phone:319-395-0159
Mailing Address - Fax:319-395-7261
Practice Address - Street 1:1350 BOYSON ROAD
Practice Address - Street 2:BLDG A
Practice Address - City:HIAWATHA
Practice Address - State:IA
Practice Address - Zip Code:52233
Practice Address - Country:US
Practice Address - Phone:319-395-0159
Practice Address - Fax:319-395-7261
Is Sole Proprietor?:No
Enumeration Date:2006-10-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA067871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0193821Medicaid