Organization
TYLER E NELSON DMD MD INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TYLER ELLIOTT NELSON DMD, MD (OWNER)
(707) 337-0996
Entity
Organization
Contact information
Practice address
2801 WATERMAN BLVD STE 240, FAIRFIELD, CA 94534-2987
(707) 428-5427
Mailing address
2801 WATERMAN BLVD STE 240, FAIRFIELD, CA 94534-2987
(707) 428-5427
Taxonomy
Speciality
Code
Description
License number
State
261QS0112X
Oral and Maxillofacial Surgery Clinic/Center
Primary
56695
CA
Other
Enumeration date
01/23/2015
Last updated
01/23/2015
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