Provider Demographics
NPI:1003598376
Name:SEAN K CARLSON, DMD, MS, INC
Entity Type:Organization
Organization Name:SEAN K CARLSON, DMD, MS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:KENNETH
Authorized Official - Last Name:CARLSON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MS
Authorized Official - Phone:415-370-2619
Mailing Address - Street 1:326 W BLITHEDALE AVE
Mailing Address - Street 2:
Mailing Address - City:MILL VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94941-1038
Mailing Address - Country:US
Mailing Address - Phone:415-888-3814
Mailing Address - Fax:
Practice Address - Street 1:7 REDWOOD DR
Practice Address - Street 2:
Practice Address - City:ROSS
Practice Address - State:CA
Practice Address - Zip Code:94957-9675
Practice Address - Country:US
Practice Address - Phone:415-746-9002
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-04
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty