1801028592 NPI number — LORI D. NELSON DDS, PA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801028592 NPI number — LORI D. NELSON DDS, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LORI D. NELSON DDS, PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1801028592
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/14/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
730 EMERSON DR. NW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PALM BAY
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32907
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
321-984-7878
Provider Business Mailing Address Fax Number:
321-953-0279

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
730 EMERSON DR. NW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PALM BAY
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32907
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
321-984-7878
Provider Business Practice Location Address Fax Number:
321-953-0279
Provider Enumeration Date:
08/14/2009

Additional Information

Authorized Official

Authorized Official Last Name:
MILLER
Authorized Official First Name:
MICHELE
Authorized Official Middle Name:
ELIZABETH
Authorized Official Title or Position:
ADMINISTRATIVE ASSISTANT
Authorized Official Telephone Number:
321-984-7878

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  10353 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 10353 . This is a "DENTIST FLORIDA LICENSE NUMBER" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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