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Active NPI 1225015977 Individual Practitioner Male Practitioner

Dr. Jacy Craig Nelson , DDS

Dentist - General Practice • Renton, WA

Professional Overview & Biography Verified Profile Summary

Dr. Jacy Nelson, DDS is a registered healthcare professional specializing in Dentist - General Practice in Renton, WA. Practice services are available at 14300 SE PETROVITSKY RD under active NPI credentials.

Practice Location & Contact Primary Location

Practice Address

14300 Se Petrovitsky Rd

Renton, WA 980588955

Telephone 2538520206
Fax 2538526351
Associated Practice Facility / Clinic
🏢 Charles R. Ingle Dds,ps Facility NPI 1144375247

Specialty Benchmarks & Practice Insights

Comparative analytics for Dentist - General Practice in Renton, WA

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 10.5 Yrs
State Avg: 21.3 Yrs
Regional Practice Density
62 Specialists

Practicing in Renton, WA (3345 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

CMS Verified: 2026-03-18
Dentist - General Practice Primary Specialty

NUCC Taxonomy Code: 1223G0001X

State License WA DE00009342

A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

4 Associated Practitioners
Dr. Tom Lee , DDS

Dentist - General Practice

NPI 1093934135

Doctor of Dental Surgery

Dr. Mario Chorak , DMD, PS

Dentist - Orthodontics and Dentofacial Orthopedics

NPI 1255591897

Doctor of Dental Medicine, PS

Hannah Lee

Dentist

NPI 1346007721
NPI 1699883660

Doctor of Dental Surgery

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

8 Historical Events
📍
Updated Practice Location March 18, 2026

Registered at 14300 SE PETROVITSKY RD, RENTON, WA 980588955 (Tel: 2538520206)

📍
Updated Business Mailing Address March 18, 2026

Registered at 14300 SE PETROVITSKY RD, RENTON, WA 980588955 (Tel: 2538520206)

NPI Profile Active July 21, 2016

NPI status registered as active in NPPES database

📍
Updated Practice Location July 21, 2016

Registered at 19221 108TH AVE SE, SUITE 2, RENTON, WA 980557369 (Tel: 2538520206)

📍
Updated Business Mailing Address July 21, 2016

Registered at 19221 108TH AVE SE STE 2, RENTON, WA 980557369 (Tel: 2538520206)

👤
Provider Name / Credentials Updated July 21, 2016

Recorded as JACY NELSON, D.D.S.

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) July 21, 2016

Dentist (License #DE00009342 in WA)

🟢
Initial NPI Registration & Enumeration December 23, 2005

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1225015977
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: December 23, 2005
Last Update: March 18, 2026
Sole Proprietor: Yes

Mailing Address

14300 Se Petrovitsky Rd

Renton, WA 980588955

Phone: 2538520206

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.