Provider Demographics
NPI:1356086979
Name:ADRIAN CARLSON & ASSOCIATES PLLC
Entity Type:Organization
Organization Name:ADRIAN CARLSON & ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:ADRIAN
Authorized Official - Middle Name:BRADLEY
Authorized Official - Last Name:CARLSON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:406-321-1068
Mailing Address - Street 1:2565 W ERIE RD
Mailing Address - Street 2:
Mailing Address - City:TEMPERANCE
Mailing Address - State:MI
Mailing Address - Zip Code:48182-9433
Mailing Address - Country:US
Mailing Address - Phone:406-321-1068
Mailing Address - Fax:
Practice Address - Street 1:3227 DEAN RD
Practice Address - Street 2:
Practice Address - City:LAMBERTVILLE
Practice Address - State:MI
Practice Address - Zip Code:48144-9614
Practice Address - Country:US
Practice Address - Phone:406-321-1068
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-28
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2901600758OtherMICHIGAN LICENSE