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General NPI Number Information
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NPI Number | 1770775975
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Entity Type | Organization
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Legal Business Name | PETER C. NELSON DDS, INC.
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Dates
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Enumeration Date | 08/13/2007
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Last Update Date | 09/18/2007
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Provider Practice Location Address
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Address Line | 1250 PEACH ST STE L
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City | SAN LUIS OBISPO
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State | CA
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Zip | 93401-2875
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Country | US
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Telephone | 805-544-1877
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Fax | 805-544-9026
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Provider Business Mailing Address
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Address Line | 1250 PEACH ST STE L
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City | SAN LUIS OBISPO
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State | CA
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Zip | 93401-2875
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Country | US
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Telephone | 805-544-1877
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Fax | 805-544-9026
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Authorized Official
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Title or Position | OWNER
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Name | DR. PETER C. NELSON
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Credential | D.D.S.
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Telephone | 805-544-1877
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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 | 21276
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License Number State | CA
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