Provider Demographics
NPI:1598146078
Name:NELSON, JAYA (DDS)
Entity Type:Individual
Prefix:MS
First Name:JAYA
Middle Name:
Last Name:NELSON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2152 ALICE AVE
Mailing Address - Street 2:APT 101
Mailing Address - City:OXON HILL
Mailing Address - State:MD
Mailing Address - Zip Code:20745-3535
Mailing Address - Country:US
Mailing Address - Phone:217-597-3521
Mailing Address - Fax:
Practice Address - Street 1:2152 ALICE AVE
Practice Address - Street 2:APT 101
Practice Address - City:OXON HILL
Practice Address - State:MD
Practice Address - Zip Code:20745-3535
Practice Address - Country:US
Practice Address - Phone:217-597-3521
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-10
Last Update Date:2015-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12012279A122300000X
IL019030166122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist