Provider Demographics
NPI:1497818652
Name:CARLSON, JULIA E (DDS)
Entity Type:Individual
Prefix:DR
First Name:JULIA
Middle Name:E
Last Name:CARLSON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2580 KIOWA BLVD N
Mailing Address - Street 2:
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86403-2551
Mailing Address - Country:US
Mailing Address - Phone:928-566-4791
Mailing Address - Fax:928-566-4793
Practice Address - Street 1:2580 KIOWA BLVD N
Practice Address - Street 2:
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86403-2551
Practice Address - Country:US
Practice Address - Phone:928-566-4791
Practice Address - Fax:928-566-4791
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA371971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice