Provider Demographics
NPI:1659306603
Name:NELSON, LARRY H (DMD)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:H
Last Name:NELSON
Suffix:
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 1:5945 WESCOTT RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29212-2717
Mailing Address - Country:US
Mailing Address - Phone:803-781-2930
Mailing Address - Fax:803-781-8566
Practice Address - Street 1:5945 WESCOTT RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29212-2717
Practice Address - Country:US
Practice Address - Phone:803-781-2930
Practice Address - Fax:803-781-8566
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC19551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice