NPIMap

Organization Active NPI

Tyler E Nelson DMD MD Inc

  • Oral and Maxillofacial Surgery Clinic/Center
  • Fairfield, CA
National Provider Identifier
1174913578
Registry record updated Jan 23, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery Clinic/CenterTaxonomy code 261QS0112X
License
56695 Issued in CA
Legal business name
TYLER E NELSON DMD MD INC
Practice address
2801 Waterman Blvd Ste 240
Fairfield, CA 94534-2987
Phone
(707) 428-5427
NPI assigned
Jan 23, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 23, 2015

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

Authorized official

Name
Tyler Elliott Nelson, DMD, MDNPI 1184860561
Title
Owner
Phone
(707) 337-0996

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Surgery Clinic/Center 261QS0112X 56695 CA Primary

Addresses

Primary practice location

2801 Waterman Blvd Ste 240
Fairfield, CA 94534-2987

Mailing address

2801 Waterman Blvd Ste 240
Fairfield, CA 94534-2987
Phone (707) 428-5427

National Provider Directory

National Provider Directory

Locations

2801 Waterman Blvd
Ste 240
Fairfield, CA 94534
Phone (707) 426-5427

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1421971200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1421971200000",
    "number": "1174913578",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2801 WATERMAN BLVD STE 240",
            "city": "FAIRFIELD",
            "state": "CA",
            "postal_code": "945342987",
            "telephone_number": "707-428-5427"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2801 WATERMAN BLVD STE 240",
            "city": "FAIRFIELD",
            "state": "CA",
            "postal_code": "945342987",
            "telephone_number": "707-428-5427"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TYLER E NELSON DMD MD INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-01-23",
        "last_updated": "2015-01-23",
        "status": "A",
        "authorized_official_last_name": "NELSON",
        "authorized_official_first_name": "TYLER",
        "authorized_official_middle_name": "ELLIOTT",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "707-337-0996",
        "authorized_official_credential": "DMD, MD"
    },
    "taxonomies": [
        {
            "code": "261QS0112X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Oral and Maxillofacial Surgery",
            "state": "CA",
            "license": "56695",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fairfield, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.