Provider Demographics
NPI:1437373495
Name:NELSON, DONALD LAWRENCE (DDS)
Entity Type:Individual
Prefix:DR
First Name:DONALD
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 1:25 EAST FOURTH STREET
Mailing Address - Street 2:FOURTH AND PINE BUILDING
Mailing Address - City:JAMESTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:14701-5056
Mailing Address - Country:US
Mailing Address - Phone:716-484-1887
Mailing Address - Fax:716-484-9040
Practice Address - Street 1:25 EAST FOURTH STREET
Practice Address - Street 2:FOURTH AND PINE BUILDING
Practice Address - City:JAMESTOWN
Practice Address - State:NY
Practice Address - Zip Code:14701-5056
Practice Address - Country:US
Practice Address - Phone:716-484-1887
Practice Address - Fax:716-484-9040
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028122122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist