Provider Demographics
NPI:1639848781
Name:NELSON, DUSTIN AMES (DDS)
Entity Type:Individual
Prefix:DR
First Name:DUSTIN
Middle Name:AMES
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 1:315 WAVERLY DR
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-1819
Mailing Address - Country:US
Mailing Address - Phone:626-533-3398
Mailing Address - Fax:
Practice Address - Street 1:1941 HUNTINGTON DR STE D
Practice Address - Street 2:
Practice Address - City:SOUTH PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91030-5601
Practice Address - Country:US
Practice Address - Phone:626-577-1819
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-11
Last Update Date:2021-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24242122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist