Provider Demographics
NPI:1427010495
Name:CARLSON, THOMAS WILLIAM (DDS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:WILLIAM
Last Name:CARLSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3001 A SIXTH ST.
Mailing Address - Street 2:NAVAL HEALTH CLINIC
Mailing Address - City:GREAT LAKES
Mailing Address - State:IL
Mailing Address - Zip Code:60088-0000
Mailing Address - Country:US
Mailing Address - Phone:847-688-2755
Mailing Address - Fax:847-688-2546
Practice Address - Street 1:3001 A SIXTH ST.
Practice Address - Street 2:NAVAL HEALTH CLINIC
Practice Address - City:GREAT LAKES
Practice Address - State:IL
Practice Address - Zip Code:60088-0000
Practice Address - Country:US
Practice Address - Phone:847-688-2755
Practice Address - Fax:847-688-2546
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-05
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice