MEDICARE: DR. JAY ANDREW 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	1223G0001X	General Practice Dentistry	DN10809	FL

General Provider Information

NPI Number	:	1780705657
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAY ANDREW NELSON DMD

Provider Business Mailing Address
First Line	:	26907 FOGGY CREEK RD STE 101
Second Line	:
City	:	WESLEY CHAPEL
State	:	FL
Zip	:	33544-6778
Country	:	US
Telephone Number	:	813-733-4169
Fax Number	:	888-977-1984

Provider Business Practice Location Address
First Line	:	26907 FOGGY CREEK RD STE 101
Second Line	:
City	:	WESLEY CHAPEL
State	:	FL
Zip	:	33544-6778
Country	:	US
Telephone Number	:	813-733-4169
Fax Number	:	888-977-1984

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

Provider Enumeration Date	:	04/02/2007
Last Update Date	:	08/24/2021

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