Lorenzo Kidd Neilsen, D.D.S.

Primary specialty

DentistTaxonomy code 122300000X

License

61219 Issued in KS

Practice address

2033 SW Sterling Dr
Lees Summit, MO 64081-4040

Phone

(801) 891-2043

Fax

(913) 451-2959

NPI assigned

Jun 21, 2016

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Jan 24, 2018 through Jan 24, 2028

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1466467200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1470528000000",
    "number": "1003266966",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2033 SW STERLING DR",
            "city": "LEES SUMMIT",
            "state": "MO",
            "postal_code": "640814040",
            "telephone_number": "801-891-2043",
            "fax_number": "913-451-2959"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2033 SW STERLING DR",
            "city": "LEES SUMMIT",
            "state": "MO",
            "postal_code": "640814040",
            "telephone_number": "801-891-2043",
            "fax_number": "913-451-2959"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NEILSEN",
        "first_name": "LORENZO",
        "middle_name": "KIDD",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-06-21",
        "last_updated": "2016-08-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "KS",
            "license": "61219",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MO",
            "license": "2016018480",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jacquelene Astrid Neal, DC
• Kirk Allen Neely, RPH
• Madison Neely, DC
• Owen H Neff Jr., RPH., MBA
• Grace Neiderhiser, PLPC
• Alec Neitzel, PA-C
• Alex Nelson, D.C.
• Caroline Nelson, PT, DPT
• Darryl K Nelson, MD
• Jennifer Nelson

• Dentist in Lees Summit, MO
• Providers in Lees Summit, MO by specialty
• Dentist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.