Provider Demographics
NPI:1619988342
Name:NELSON, LILLIAN ADAME (DDS)
Entity Type:Individual
Prefix:DR
First Name:LILLIAN
Middle Name:ADAME
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 1:925 E LOS EBANOS BLVD
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78520-8726
Mailing Address - Country:US
Mailing Address - Phone:956-542-1177
Mailing Address - Fax:956-542-0033
Practice Address - Street 1:925 E LOS EBANOS BLVD
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78520-8726
Practice Address - Country:US
Practice Address - Phone:956-542-1177
Practice Address - Fax:956-542-0033
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX189881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB18988-02OtherCHIP LOS FRESNOS
TX89D288OtherBC/BS
TX1810147OtherUNITED CONCORDIA
TXB18988-01OtherBROWNSVILLE