Provider Demographics
NPI:1467519520
Name:NELSON, LIONEL MATTHEW SR (DMD)
Entity Type:Individual
Prefix:DR
First Name:LIONEL
Middle Name:MATTHEW
Last Name:NELSON
Suffix:SR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3325 DURHAM CHAPEL HILL BLVD
Mailing Address - Street 2:SUITE 303
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-6235
Mailing Address - Country:US
Mailing Address - Phone:919-489-0497
Mailing Address - Fax:919-493-2264
Practice Address - Street 1:3325 DURHAM CHAPEL HILL BLVD
Practice Address - Street 2:SUITE 303
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-6235
Practice Address - Country:US
Practice Address - Phone:919-489-0497
Practice Address - Fax:919-493-2264
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-01
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7158122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8990145Medicaid