MEDICARE: L SPENCE NELSON DMD MDS PC

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	104648	CO

General Provider Information

NPI Number	:	1801818851
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	L SPENCE NELSON DMD MDS PC

Provider Business Mailing Address
First Line	:	5731 SILVERSTONE TER STE 280
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80919-3542
Country	:	US
Telephone Number	:	719-278-5005
Fax Number	:

Provider Business Practice Location Address
First Line	:	5731 SILVERSTONE TER STE 280
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80919-3542
Country	:	US
Telephone Number	:	719-278-5005
Fax Number	:

Authorized Official
Title or Position	:	ORTHODONTIST
Name	:	DR. L SPENCE NELSON
Credential	:	DMD MDS PC
Telephone Number	:	719-278-5005

Provider Enumeration Date	:	07/25/2006
Last Update Date	:	08/22/2020

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