Provider Demographics
NPI:1548678295
Name:NELSON, KRISTIN (DDS, MSD)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:NELSON
Suffix:
Gender:F
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 STONE POINT DR
Mailing Address - Street 2:275
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-7087
Mailing Address - Country:US
Mailing Address - Phone:240-449-5859
Mailing Address - Fax:
Practice Address - Street 1:22855 BRAMBLETON PLZ
Practice Address - Street 2:200
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20148-4870
Practice Address - Country:US
Practice Address - Phone:703-327-1718
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-25
Last Update Date:2014-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014145621223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics