Provider Demographics
NPI:1851658793
Name:NELSON, LORA LYNNE (DDS)
Entity Type:Individual
Prefix:DR
First Name:LORA
Middle Name:LYNNE
Last Name:NELSON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:LORA
Other - Middle Name:LYNNE
Other - Last Name:SCHMITT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:19033 US 71
Mailing Address - Street 2:
Mailing Address - City:PARK RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:56470-3202
Mailing Address - Country:US
Mailing Address - Phone:218-732-3291
Mailing Address - Fax:218-237-2532
Practice Address - Street 1:19033 US 71
Practice Address - Street 2:
Practice Address - City:PARK RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:56470-3202
Practice Address - Country:US
Practice Address - Phone:218-732-3291
Practice Address - Fax:218-237-2532
Is Sole Proprietor?:No
Enumeration Date:2012-04-17
Last Update Date:2020-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND130781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice