Provider Demographics
NPI:1467948372
Name:CARLSON, ZACHARY ANDERS (DDS)
Entity Type:Individual
Prefix:DR
First Name:ZACHARY
Middle Name:ANDERS
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 1:11601 W HWY 290 STE B105
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78737-2858
Mailing Address - Country:US
Mailing Address - Phone:512-917-4550
Mailing Address - Fax:512-532-6431
Practice Address - Street 1:11601 W HWY 290 STE B105
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78737-2858
Practice Address - Country:US
Practice Address - Phone:512-917-4550
Practice Address - Fax:512-532-6431
Is Sole Proprietor?:No
Enumeration Date:2018-07-03
Last Update Date:2018-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX343241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice