MEDICARE: DR. NELSON D LASITER DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0700X	Prosthodontics	S5-04	NV

General Provider Information

NPI Number	:	1730181850
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NELSON D LASITER DMD

Provider Business Mailing Address
First Line	:	2255 RENAISSANCE DR
Second Line	:	STE B
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-6167
Country	:	US
Telephone Number	:	702-798-1987
Fax Number	:

Provider Business Practice Location Address
First Line	:	2255 RENAISSANCE DR
Second Line	:	STE B
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-6167
Country	:	US
Telephone Number	:	702-798-1987
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	07/08/2007

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