MEDICARE: DR. CRAIG LIVEZEY NELSON DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0700X	Prosthodontics	3340	SC
2	1223P0700X	Prosthodontics	475	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3340	OTHER	SC	DENTAL LICENSE

General Provider Information

NPI Number	:	1306861653
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CRAIG LIVEZEY NELSON DMD

Provider Business Mailing Address
First Line	:	1257 WATERFRONT DRIVE
Second Line	:
City	:	MOUNT PLEASANT
State	:	SC
Zip	:	29464-9494
Country	:	US
Telephone Number	:	843-849-7046
Fax Number	:

Provider Business Practice Location Address
First Line	:	VA HEALTH CARE SYSTEM
Second Line	:	10,000 BAY PINES BOULVARD
City	:	SAINT PETERSBURG
State	:	FL
Zip	:	33708
Country	:	US
Telephone Number	:	727-398-9396
Fax Number	:	727-319-1146

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/13/2006
Last Update Date	:	09/11/2025

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