Provider Demographics
NPI:1699825612
Name:NELSON, LEZLIE ANN (DDS)
Entity Type:Individual
Prefix:DR
First Name:LEZLIE
Middle Name:ANN
Last Name:NELSON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:LEZLIE
Other - Middle Name:ANN
Other - Last Name:NELSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:1320 NILES AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55116-1631
Mailing Address - Country:US
Mailing Address - Phone:651-222-0983
Mailing Address - Fax:
Practice Address - Street 1:375 JACKSON ST STE 200
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55101-1806
Practice Address - Country:US
Practice Address - Phone:651-222-0983
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND107131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice