Provider Demographics
NPI:1760582357
Name:NELSON, DENNIS LYNN (DDS)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:LYNN
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 1:110 KIMBALL AVE
Mailing Address - Street 2:SUITE 230
Mailing Address - City:SOUTH BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05403-6833
Mailing Address - Country:US
Mailing Address - Phone:802-864-6264
Mailing Address - Fax:802-864-6402
Practice Address - Street 1:110 KIMBALL AVE
Practice Address - Street 2:SUITE 230
Practice Address - City:SOUTH BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403-6833
Practice Address - Country:US
Practice Address - Phone:802-864-6264
Practice Address - Fax:802-864-6402
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT6121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice