Healthcare Provider Details

I. General information

NPI: 1609890276
Provider Name (Legal Business Name): L SPENCE NELSON DMD MDS PC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5731 SILVERSTONE TER STE 280
COLORADO SPRINGS CO
80919-3542
US

IV. Provider business mailing address

5731 SILVERSTONE TER STE 280
COLORADO SPRINGS CO
80919-3542
US

V. Phone/Fax

Practice location:
  • Phone: 719-278-5005
  • Fax: 719-278-5007
Mailing address:
  • Phone: 719-278-5005
  • Fax: 719-278-5007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number104648
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: