Theodore R. Nelson, DDS, PC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

16384 Issued in MA

Legal business name

THEODORE R. NELSON, DDS, PC

Practice address

387 Sterling St
S. Lancaster, MA 01561

Phone

(978) 365-5302

Fax

(978) 598-7072

NPI assigned

Nov 27, 2006

Last updated

Mar 25, 2016By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Theodore R. Nelson, DDSNPI 1316190804

Title

President Ceo

Phone

(978) 365-5302

Specialties & licenses 1

Addresses

Other names 1

• Theodore R Nelson DDS Former legal business name

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Theodore Read Nelson, DDS

  • General Practice Dentistry
  • Lancaster, MA
  • NPI 1316190804
  NPD (past) Authorized official

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

{
    "created_epoch": "1164585600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1458864000000",
    "number": "1992871586",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 607",
            "city": "S LANCASTER",
            "state": "MA",
            "postal_code": "015610607",
            "telephone_number": "978-365-5302",
            "fax_number": "978-598-7072"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "387 STERLING ST",
            "city": "S. LANCASTER",
            "state": "MA",
            "postal_code": "01561",
            "telephone_number": "978-365-5302",
            "fax_number": "978-598-7072"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THEODORE R. NELSON, DDS, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-27",
        "last_updated": "2016-03-25",
        "status": "A",
        "authorized_official_last_name": "NELSON",
        "authorized_official_first_name": "THEODORE",
        "authorized_official_middle_name": "R.",
        "authorized_official_title_or_position": "PRESIDENT CEO",
        "authorized_official_telephone_number": "978-365-5302",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MA",
            "license": "16384",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Theodore R Nelson DDS",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2016; 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.