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General NPI Number Information
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NPI Number | 1073833844
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Entity Type | Individual
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Provider Name | DAVID LYMAN NELSON D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 06/03/2010
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Last Update Date | 07/29/2020
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Provider Practice Location Address
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Address Line | 10717 CAMINO RUIZ STE 103
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City | SAN DIEGO
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State | CA
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Zip | 92126-2310
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Country | US
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Telephone | 858-536-1111
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Fax |
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Provider Business Mailing Address
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Address Line | 3932 JEWELL ST APT N311
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City | SAN DIEGO
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State | CA
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Zip | 92109-6059
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Country | US
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Telephone | 512-677-5056
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | DDS103543
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License Number State | CA
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