Provider Demographics
NPI:1740479633
Name:NELSON, DOROTHY SUE (DDS)
Entity type:Individual
Prefix:
First Name:DOROTHY
Middle Name:SUE
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 1:230 E FIFTH AVE
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-4906
Mailing Address - Country:US
Mailing Address - Phone:760-738-9595
Mailing Address - Fax:760-738-9596
Practice Address - Street 1:230 E FIFTH AVE
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-4906
Practice Address - Country:US
Practice Address - Phone:760-738-9595
Practice Address - Fax:760-738-9596
Is Sole Proprietor?:No
Enumeration Date:2007-10-17
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42075122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist