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General NPI Number Information
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NPI Number | 1306861653
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Entity Type | Individual
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Provider Name | CRAIG LIVEZEY NELSON DMD
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Gender | Male
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Dates
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Enumeration Date | 07/13/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | VA HEALTH CARE SYSTEM 10,000 BAY PINES BOULVARD
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City | SAINT PETERSBURG
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State | FL
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Zip | 33708
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Country | US
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Telephone | 727-398-9396
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Fax | 727-319-1146
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Provider Business Mailing Address
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Address Line | 1257 WATERFRONT DRIVE
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City | MOUNT PLEASANT
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State | SC
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Zip | 29464-9494
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Country | US
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Telephone | 843-849-7046
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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 | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | 3340
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | 475
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License Number State | SC
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