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General NPI Number Information
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NPI Number | 1275727000
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Entity Type | Individual
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Provider Name | TIFFANY LYNN NELSON DDS
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Gender | Female
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Dates
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Enumeration Date | 09/05/2007
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Last Update Date | 12/04/2019
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Provider Practice Location Address
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Address Line | 320 WEST MYRTLE ST STE 100
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City | DULUTH
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State | MN
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Zip | 55811
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Country | US
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Telephone | 218-491-8058
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Fax |
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Provider Business Mailing Address
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Address Line | 4325 GRAND AVE APT 308
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City | DULUTH
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State | MN
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Zip | 55807-2730
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Country | US
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Telephone | 218-628-7035
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Fax | 218-624-6594
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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 | 14107
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License Number State | MN
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