Tyler Elliott Nelson, D.M.D.

Primary specialty

DentistTaxonomy code 122300000X

License

56695 Issued in CA

Practice address

2801 Waterman Blvd Ste 240
Fairfield, CA 94534-2987

Phone

(707) 428-5427

Fax

(707) 428-1922

NPI assigned

Jan 6, 2009

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

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.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Tyler E Nelson DMD MD Inc

  • Oral and Maxillofacial Surgery Clinic/Center
  • Fairfield, CA
  • NPI 1174913578
  NPD (past) Authorized official

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

{
    "created_epoch": "1231200000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1469059200000",
    "number": "1184860561",
    "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",
            "fax_number": "707-428-1922"
        },
        {
            "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",
            "fax_number": "707-428-1922"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NELSON",
        "first_name": "TYLER",
        "middle_name": "ELLIOTT",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-01-06",
        "last_updated": "2016-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "56695",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Madhavi -------------------- Neerumalla, D.D.S
• Mikayla Renee Negron-Foster
• Grace Nelson
• Kima Kristi Nelson
• Sharayah Brooke Nelson, CATC
• Heidi Nemeth, RN
• Felicia Rose Nepomuceno, AU.D.
• Jennifer Marie Neta, PT
• Lequita Karen Nethington
• Christina Nevarez, RN

• Dentist in Fairfield, CA
• Providers in Fairfield, CA by specialty
• Dentist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.