Provider Demographics
NPI:1689461261
Name:NIELSEN DENTAL PLLC
Entity type:Organization
Organization Name:NIELSEN DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JUANA
Authorized Official - Middle Name:
Authorized Official - Last Name:PECK CRAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-463-3443
Mailing Address - Street 1:2511 W MORTON ST
Mailing Address - Street 2:
Mailing Address - City:DENISON
Mailing Address - State:TX
Mailing Address - Zip Code:75020-1473
Mailing Address - Country:US
Mailing Address - Phone:903-463-3443
Mailing Address - Fax:903-465-1134
Practice Address - Street 1:2511 W MORTON ST
Practice Address - Street 2:
Practice Address - City:DENISON
Practice Address - State:TX
Practice Address - Zip Code:75020-1473
Practice Address - Country:US
Practice Address - Phone:903-463-3443
Practice Address - Fax:903-465-1134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-24
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty