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General NPI Number Information
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NPI Number | 1326313511
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Entity Type | Organization
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Legal Business Name | THOMAS L NELSON DDS MBA LTD
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Dates
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Enumeration Date | 03/20/2012
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Last Update Date | 02/02/2017
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Provider Practice Location Address
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Address Line | 360 W BUTTERFIELD RD SUITE 180
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City | ELMHURST
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State | IL
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Zip | 60126-5068
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Country | US
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Telephone | 630-832-3120
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Fax | 630-832-3730
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Provider Business Mailing Address
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Address Line | 360 W BUTTERFIELD RD SUITE 180
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City | ELMHURST
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State | IL
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Zip | 60126-5068
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Country | US
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Telephone | 630-832-3120
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Fax | 630-832-3730
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. THOMAS L NELSON
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Credential | DDS
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Telephone | 630-832-3120
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 019019401
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License Number State | IL
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