Provider Demographics
NPI:1053319558
Name:NIELSEN, STEVEN JEROME (DDS)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:JEROME
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 1:5851 DULUTH ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55422-3946
Mailing Address - Country:US
Mailing Address - Phone:763-546-1301
Mailing Address - Fax:763-546-0905
Practice Address - Street 1:5851 DULUTH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55422-3946
Practice Address - Country:US
Practice Address - Phone:763-546-1301
Practice Address - Fax:763-546-0905
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNMN 77631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice