Healthcare Provider Details

I. General information

NPI: 1801818851
Provider Name (Legal Business Name): L SPENCE NELSON DMD MDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 08/22/2020
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:
Mailing address:
  • Phone: 719-278-5005
  • Fax:

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: DR. L SPENCE NELSON
Title or Position: ORTHODONTIST
Credential: DMD MDS PC
Phone: 719-278-5005