Provider Demographics
NPI:1003266966
Name:NEILSEN, LORENZO KIDD (DDS)
Entity Type:Individual
Prefix:DR
First Name:LORENZO
Middle Name:KIDD
Last Name:NEILSEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2033 SW STERLING DR
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64081-4040
Mailing Address - Country:US
Mailing Address - Phone:801-891-2043
Mailing Address - Fax:913-451-2959
Practice Address - Street 1:2033 SW STERLING DR
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64081-4040
Practice Address - Country:US
Practice Address - Phone:801-891-2043
Practice Address - Fax:913-451-2959
Is Sole Proprietor?:No
Enumeration Date:2016-06-21
Last Update Date:2016-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS61219122300000X
MO2016018480122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist