Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 40098 | CA |
NPI | 1003814138 |
---|---|
Provider Name | Dr. Jeffrey Lawrence Nelson |
First Address | Placerville, CA 95667-3805 |
Second Address | Placerville, CA 95667-3920 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2005 |
Last Update Date | 08/07/2007 |