Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | DDS103543 | CA |
NPI | 1073833844 |
---|---|
Provider Name | Dr. David Lyman Nelson |
First Address | San Diego, CA 92109-6059 |
Second Address | San Diego, CA 92126-2310 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/06/2010 |
Last Update Date | 29/07/2020 |