Provider Demographics
NPI:1407809007
Name:R CHRISTOPHER CARSON DDS, INC
Entity Type:Organization
Organization Name:R CHRISTOPHER CARSON DDS, INC
Other - Org Name:DENTAL HEALTH GROUP OF CHAGRIN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT, DDS
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:C
Authorized Official - Last Name:CARSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:440-543-1234
Mailing Address - Street 1:8505 TANGLEWOOD SQ STE T17
Mailing Address - Street 2:
Mailing Address - City:CHAGRIN FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44023-6400
Mailing Address - Country:US
Mailing Address - Phone:440-543-1234
Mailing Address - Fax:440-543-1205
Practice Address - Street 1:8505 TANGLEWOOD SQ STE T17
Practice Address - Street 2:
Practice Address - City:CHAGRIN FALLS
Practice Address - State:OH
Practice Address - Zip Code:44023-6400
Practice Address - Country:US
Practice Address - Phone:440-543-1234
Practice Address - Fax:440-543-1205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2018-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH208911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0248269Medicaid
OH2193246Medicaid