Provider Demographics
NPI:1780705657
Name:NELSON, JAY ANDREW (DMD)
Entity type:Individual
Prefix:DR
First Name:JAY
Middle Name:ANDREW
Last Name:NELSON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26907 FOGGY CREEK RD STE 101
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33544-6778
Mailing Address - Country:US
Mailing Address - Phone:813-733-4169
Mailing Address - Fax:888-977-1984
Practice Address - Street 1:26907 FOGGY CREEK RD STE 101
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33544-6778
Practice Address - Country:US
Practice Address - Phone:813-733-4169
Practice Address - Fax:888-977-1984
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN108091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice