DR. MARK L NELSON (NPI# 1215997663) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1215997663 |
| Entity Type | Individual |
| Full Name | DR. MARK L NELSON |
| Credential | D.D.S |
| Practice Address |
1551 Renaissance Towne Dr Suite 540 Bountiful UT 84010-7667 |
| Practice Telephone | 8012958322 |
| Practice Fax Number | 8012957694 |
| Mailing Telephone | 8012958322 |
| Mailing Fax Number | 8012957694 |
| Enumeration Date | 2006-03-27 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | X |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223P0221X |
Dentist Specialization: Pediatric Dentistry |
141802 | UT | Dental Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| UT | UNITED CONCORDIA | 562460 | 01 |
| UT | TAX ID FOR MISC INSURANCE | 870542081 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518459734 | Mark Alexander Nelson | Pharmacist | 111 Acklen Park Dr Apt 117, Nashville, TN 37203-1144 | 2018-06-04 |
| 1457666133 | Mark D Nelson | Physical Therapy Assistant | 104 S 3rd St W, Ada, MN 56510-1520 | 2010-08-18 |
| 1457683773 | Mark Daniel Nelson | Chiropractor | 21168 Buchanan St Ne, Cedar, MN 55011-4425 | 2010-02-11 |
| 1710212022 | Mark E Nelson | Optometrist | 3333 S Highway 75, Sherman, TX 75090-9377 | 2009-10-05 |
| 1396972279 | Mark Andrew Nelson | Internal Medicine | 1960 N Ogden St Ste 120, Denver, CO 80218 | 2009-06-17 |
| 1790932432 | Mark Stephen Nelson | Internal Medicine | 4500 S Lancaster Rd # 11qc, Dallas, TX 75216-7167 | 2008-08-25 |
| 1801053186 | Mark Alan Nelson | Dentist | 102 Janesville Street, Oregon, WI 53575-1527 | 2008-05-22 |
| 1124043583 | Mark W Nelson | Dentist | 204 Highway 12 E, Hettinger, ND 58639-9687 | 2006-07-13 |
| 1689647109 | Mark Lewis Nelson | Ophthalmology | 2245 S 19th St, 200, Tacoma, WA 98405-2945 | 2006-02-08 |
| 1639153463 | Mark Linder Nelson | Nurse Anesthetist, Certified Registered | 2248 Elcid Ct, Palm Harbor, FL 34683-6730 | 2005-12-05 |
| Street Address |
1551 RENAISSANCE TOWNE DR SUITE 540 |
| City | BOUNTIFUL |
| State | UT |
| Zip Code | 84010-7667 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548261431 | Curtis Brian Jolley | Physical Therapist | 1551 Renaissance Towne Dr, Ste 350, Bountiful, UT 84010-7667 | 2005-08-02 |
| 1346776127 | Kelli R Loveland | Audiologist | 1551 Renaissance Towne Dr, Bountiful, UT 84010 | 2017-05-11 |
| 1235505587 | Children's Dentistry | Dentist | 1551 Renaissance Towne Dr, Ste 540, Bountiful, UT 84010-7667 | 2015-08-20 |
| 1811370836 | Melanie Chamberlain | Physical Therapist | 1551 Renaissance Towne Dr, Ste 350, Bountiful, UT 84010-7667 | 2015-07-08 |
| 1306236492 | Jared J Tyson Md PC | Specialist | 1551 Renaissance Towne Dr, Suite 400, Bountiful, UT 84010-7667 | 2015-01-28 |
| 1033522933 | Jill Freitas Calderwood | Audiologist | 1551 Renaissance Towne Dr, Bountiful, UT 84010-7667 | 2014-06-09 |
| 1326475831 | Michelle Horne | Specialist/Technologist | 1551 Renaissance Towne Dr, Suite 420, Bountiful, UT 84010-7667 | 2013-09-28 |
| 1194098020 | Jordan Scott Carver | Pharmacist | 1551 Renaissance Towne Dr, #104, Bountiful, UT 84010-7667 | 2012-02-23 |
| 1790066124 | Stuart Chase Sondrup | Physical Therapist | 1551 Renaissance Towne Dr, Ste 350, Bountiful, UT 84010-7667 | 2011-08-30 |
| 1376821587 | Canyon Ridge Pain and Spine PC | Pain Medicine | 1551 Renaissance Towne Dr, Suite 460, Bountiful, UT 84010-7667 | 2011-07-22 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225699192 | Jessyca K Willie | Behavior Technician | 415 S. Medical Drive Suite D101, Bountiful, UT 84010 | 2019-06-21 |
| 1336634344 | Shanna Joy Jaggers | Social Worker | 2333 S 200 E, Bountiful, UT 84010 | 2018-06-22 |
| 1447773171 | Live Life Alarms | Emergency Response System Companies | 640 South 500 West, Bountiful, UT 84010 | 2017-07-25 |
| 1902328842 | Hailey Embley | Behavior Technician | 415 Medical Drive D 101, Bountiful, UT 84010 | 2017-07-12 |
| 1508318031 | Beverly Nielsen | Psychologist | 1001 Lakeview Drive, Bountiful, UT 84010 | 2016-11-01 |
| 1295287720 | Samantha Oslund | Speech-Language Pathologist | 415 Medical Dr Ste B102, Bountiful, UT 84010 | 2016-11-01 |
| 1750748273 | Jeremy Clark Morris | Dentist | 59 W 1600 N, Suite 110, Bountiful, UT 84010 | 2016-01-28 |
| 1629464706 | Shane James | Speech-Language Pathologist | 425 Medical Dr Ste 122, Bountiful, UT 84010 | 2015-04-15 |
| 1891186102 | Kenton Francis | Social Worker | 1355 North Main Street #1, Bountiful, UT 84010 | 2015-02-09 |
| 1205233855 | Modern Dental Professionals - Utah, PC | Dentist | 24 S. 500 West, #a, Bountiful, UT 84010 | 2014-11-25 |
| Find all providers in zip 84010 | ||||
| Taxonomy Code | 1223P0221X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Pediatric Dentistry |
| An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841891462 | South Davis Pediatric Dentistry LLC | Dentist | 59 W Pages Ln Ste 110, Bountiful, UT 84010-5988 | 2020-11-02 |
| 1750748273 | Jeremy Clark Morris | Dentist | 59 W 1600 N, Suite 110, Bountiful, UT 84010 | 2016-01-28 |
| 1598885659 | Colleen P Taylor | Dentist | 535 E Medical Drive, Bountiful, UT 84010 | 2007-03-30 |
| 1770001612 | Creek Capital Orchard Drive LLC | Dentist | 3377 Orchard Dr, Bountiful, UT 84010-8005 | 2017-08-30 |
| 1235505587 | Children's Dentistry | Dentist | 1551 Renaissance Towne Dr, Ste 540, Bountiful, UT 84010-7667 | 2015-08-20 |
| 1720290802 | Chris Reed Simonsen | Dentist | 535 E 500 S, Bountiful, UT 84010-3873 | 2007-05-03 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376176198 | Happy Tooth Pediatric Dentistry, LLC | Dentist | 2453 E 3300 S, Millcreek, UT 84109-2725 | 2020-02-20 |
| 1750932273 | Michael R. Brown Dds Ms | Dentist | 1240 E 100 S Ste 120, St George, UT 84790-3079 | 2019-09-25 |
| 1609438357 | Children's Landing Pediatric Dentistry, PC | Dentist | 3855 W 7800 S Ste 200, West Jordan, UT 84088-5563 | 2019-07-02 |
| 1841766821 | Dry Creek Pediatric Dentistry | Dentist | 3300 N Running Creek Way F101, Lehi, UT 84043 | 2018-10-17 |
| 1639654684 | Clubhouse Pediatric Dentistry of West Jordan | Dentist | 1108 E South Union Ave, Midvale, UT 84047-2904 | 2018-09-26 |
| 1639667801 | St. George Kids Dental At Snow Canyon | Dentist | 1100 Canyon View Dr Ste A, Santa Clara, UT 84765-5672 | 2018-04-24 |
| 1376044313 | Slpd Cottonwood LLC | Dentist | 7167 South Highland Drive, 200, Cottonwood Heights, UT 84121 | 2018-02-26 |
| 1013420553 | Kevin Brown Dmd, LLC | Dentist | 1030 S 1100 W, Suite B, Lehi, UT 84043 | 2017-11-07 |
| 1518478742 | Lcr Dental Sugar House | Dentist | 2068 S 2100 E Suite #a, Salt Lake City, UT 84108 | 2017-10-16 |
| 1952829897 | Creek Capital Oquirrh Park LLC | Dentist | 6973 S 4800 W Ste C, West Jordan, UT 84084-7927 | 2017-08-30 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.