Provider Demographics
NPI:1538862925
Name:NELSON, JEREMY PARKER (DDS)
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:PARKER
Last Name:NELSON
Suffix:
Gender:
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2344 N MERRIT CRK LOOP
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-4950
Mailing Address - Country:US
Mailing Address - Phone:208-676-8500
Mailing Address - Fax:
Practice Address - Street 1:2344 N MERRIT CRK LOOP
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-4950
Practice Address - Country:US
Practice Address - Phone:208-676-8500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-23
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD-5535122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist