Provider Demographics
NPI:1316156763
Name:NELSON, PAUL ERNEST (DDS)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:ERNEST
Last Name:NELSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 N STATE COLLEGE BLVD
Mailing Address - Street 2:SUITE I
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92831-4236
Mailing Address - Country:US
Mailing Address - Phone:714-992-0092
Mailing Address - Fax:714-992-2154
Practice Address - Street 1:100 N STATE COLLEGE BLVD
Practice Address - Street 2:SUITE I
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92831-4236
Practice Address - Country:US
Practice Address - Phone:714-992-0092
Practice Address - Fax:714-992-2154
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2009-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA347451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice