Active NPI
Phillip Logan Nelson Jr., DMD
- Dentist
- Cape Coral, FL
National Provider Identifier
1447097662
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DN29377
- Practice address
- 305 SW Pine Island Rd Unit 1
Cape Coral, FL 33991-2044 - Phone
- (239) 549-0448
- NPI assigned
- Jul 15, 2024
- Last updated
- Jul 15, 2024
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | DN29377 | FL | Primary |
Addresses
Primary practice location
305 SW Pine Island Rd Unit 1
Cape Coral, FL 33991-2044
Mailing address
305 SW Pine Island Rd Unit 1
Cape Coral, FL 33991-2044
Phone (239) 549-0448
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DN29377 | FL | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1721001600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1721001600000",
"number": "1447097662",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "305 SW PINE ISLAND RD UNIT 1",
"city": "CAPE CORAL",
"state": "FL",
"postal_code": "339912044",
"telephone_number": "239-549-0448"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "305 SW PINE ISLAND RD UNIT 1",
"city": "CAPE CORAL",
"state": "FL",
"postal_code": "339912044",
"telephone_number": "239-549-0448"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NELSON",
"first_name": "PHILLIP",
"middle_name": "LOGAN",
"name_prefix": "Dr.",
"name_suffix": "Jr.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2024-07-15",
"last_updated": "2024-07-15",
"certification_date": "2024-07-14",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "FL",
"license": "DN29377",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Cape Coral, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.