Provider Demographics
NPI:1659584951
Name:NELSON, LEE (DDS)
Entity Type:Individual
Prefix:DR
First Name:LEE
Middle Name:
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 1:2130 RALSTON AVE STE 2A
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94002-1664
Mailing Address - Country:US
Mailing Address - Phone:650-592-5673
Mailing Address - Fax:650-592-0880
Practice Address - Street 1:2130 RALSTON AVE STE 2A
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:CA
Practice Address - Zip Code:94002-1664
Practice Address - Country:US
Practice Address - Phone:650-592-5673
Practice Address - Fax:650-592-0880
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA237891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice