Provider Demographics
NPI:1801818851
Name:L SPENCE NELSON DMD MDS PC
Entity Type:Organization
Organization Name:L SPENCE NELSON DMD MDS PC
Other - Org Name:NELSON ORTHODONTICS
Other - Org Type:Other Name
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:L
Authorized Official - Middle Name:SPENCE
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD MDS PC
Authorized Official - Phone:719-278-5005
Mailing Address - Street 1:5731 SILVERSTONE TER STE 280
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80919-3542
Mailing Address - Country:US
Mailing Address - Phone:719-278-5005
Mailing Address - Fax:
Practice Address - Street 1:5731 SILVERSTONE TER STE 280
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80919-3542
Practice Address - Country:US
Practice Address - Phone:719-278-5005
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1046481223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty