Provider Demographics
NPI:1124118245
Name:NIELSEN, PAMELA LORETTA (DDS)
Entity type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:LORETTA
Last Name:NIELSEN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7755 SW 87TH AVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-2534
Mailing Address - Country:US
Mailing Address - Phone:305-279-2828
Mailing Address - Fax:305-279-1441
Practice Address - Street 1:7755 SW 87TH AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-2534
Practice Address - Country:US
Practice Address - Phone:305-279-2828
Practice Address - Fax:305-279-1441
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN00135911223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics