Provider Demographics
NPI:1396399663
Name:CARLSON DENTAL PLLC
Entity Type:Organization
Organization Name:CARLSON DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VANCE
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:CARLSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:303-932-6018
Mailing Address - Street 1:7325 S. PIERCE ST SUITE 200
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80128
Mailing Address - Country:US
Mailing Address - Phone:303-932-6018
Mailing Address - Fax:303-978-9152
Practice Address - Street 1:7325 S. PIERCE ST SUITE 200
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80128
Practice Address - Country:US
Practice Address - Phone:303-932-6018
Practice Address - Fax:303-978-9152
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-25
Last Update Date:2019-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty