Provider Demographics
NPI:1003814138
Name:NELSON, JEFFREY LAWRENCE (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:LAWRENCE
Last Name:NELSON
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 1:1861 HEATHER HILL RD
Mailing Address - Street 2:
Mailing Address - City:PLACERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95667-3805
Mailing Address - Country:US
Mailing Address - Phone:530-622-7893
Mailing Address - Fax:530-622-2943
Practice Address - Street 1:344 PLACERVILLE DR
Practice Address - Street 2:SUITE 19
Practice Address - City:PLACERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95667-3920
Practice Address - Country:US
Practice Address - Phone:530-626-9127
Practice Address - Fax:530-626-9419
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40098122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist