Provider Demographics
NPI:1316953599
Name:NELSON, ROBERT LEE (DDS)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:LEE
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 1:13018 STATE LINE RD
Mailing Address - Street 2:
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66209-1756
Mailing Address - Country:US
Mailing Address - Phone:913-498-8899
Mailing Address - Fax:913-498-8877
Practice Address - Street 1:13018 STATE LINE RD
Practice Address - Street 2:
Practice Address - City:LEAWOOD
Practice Address - State:KS
Practice Address - Zip Code:66209-1756
Practice Address - Country:US
Practice Address - Phone:913-498-8899
Practice Address - Fax:913-498-8877
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2015-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS52121223G0001X
MO123091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice