Provider Demographics
NPI:1508835687
Name:CARLSON, STEVEN WAYNE (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:WAYNE
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 1:2575 MONTEBELLO DR WEST
Mailing Address - Street 2:# 203
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918
Mailing Address - Country:US
Mailing Address - Phone:719-598-8886
Mailing Address - Fax:719-598-0531
Practice Address - Street 1:2575 MONTEBELLO DR WEST
Practice Address - Street 2:# 203
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918
Practice Address - Country:US
Practice Address - Phone:719-598-8886
Practice Address - Fax:719-598-0531
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO8300122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist