Healthcare Provider Details

I. General information

NPI: 1922524057
Provider Name (Legal Business Name): JAMES R. NELSON, DDS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2017
Last Update Date: 08/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3939 HOUMA BLVD STE 11
METAIRIE LA
70006-2921
US

IV. Provider business mailing address

3939 HOUMA BLVD STE 11
METAIRIE LA
70006-2921
US

V. Phone/Fax

Practice location:
  • Phone: 504-887-3311
  • Fax:
Mailing address:
  • Phone: 504-887-3311
  • Fax: 504-887-3326

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number6368
License Number StateLA

VIII. Authorized Official

Name: DR. JAMES ROBERT NELSON
Title or Position: OWNER
Credential: DDS
Phone: 225-205-0075