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General NPI Number Information
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NPI Number | 1629282504
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Entity Type | Individual
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Provider Name | LORI DIANNE NELSON DDS
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Gender | Female
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Dates
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Enumeration Date | 05/09/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 730 EMERSON DR. NW
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City | PALM BAY
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State | FL
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Zip | 32907
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Country | US
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Telephone | 321-984-7878
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Fax | 321-953-0279
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Provider Business Mailing Address
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Address Line | 3212 BELLWIND CIR
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City | ROCKLEDGE
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State | FL
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Zip | 32955-5157
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Country | US
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Telephone | 321-984-7878
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Fax | 321-953-0279
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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 | 10353
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License Number State | FL
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