Provider Demographics
NPI:1073833844
Name:NELSON, DAVID LYMAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:LYMAN
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 1:3932 JEWELL ST APT N311
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92109-6059
Mailing Address - Country:US
Mailing Address - Phone:512-677-5056
Mailing Address - Fax:
Practice Address - Street 1:10717 CAMINO RUIZ STE 103
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92126-2310
Practice Address - Country:US
Practice Address - Phone:858-536-1111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-03
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS1035431223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry