Organization
LORI D. NELSON DDS, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHELE ELIZABETH MILLER (ADMINISTRATIVE ASSISTANT)
(321) 984-7878
Entity
Organization
Contact information
Practice address
730 EMERSON DR. NW, PALM BAY, FL 32907
(321) 984-7878
(321) 953-0279
Mailing address
730 EMERSON DR. NW, PALM BAY, FL 32907
(321) 984-7878
(321) 953-0279
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
10353
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10353
DENTIST FLORIDA LICENSE NUMBER
FL
Enumeration date
08/14/2009
Last updated
08/14/2009
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