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General NPI Number Information
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NPI Number | 1124517735
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Entity Type | Individual
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Provider Name | JIMAN C NELSON DMD, MS
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Gender | Male
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Dates
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Enumeration Date | 05/09/2018
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Last Update Date | 02/12/2024
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Provider Practice Location Address
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Address Line | 2400 MID LN STE 350
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City | HOUSTON
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State | TX
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Zip | 77027-4466
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Country | US
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Telephone | 713-714-4245
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Fax |
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Provider Business Mailing Address
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Address Line | 2400 MID LN STE 350
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City | HOUSTON
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State | TX
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Zip | 77027-4466
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Country | US
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Telephone | 713-714-4245
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 4007-18
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 35543
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License Number State | TX
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