Provider Demographics
NPI:1508986779
Name:CARLSON, CHRISTOPHER PAUL (DMD, MS)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:PAUL
Last Name:CARLSON
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55812-2116
Mailing Address - Country:US
Mailing Address - Phone:218-727-3789
Mailing Address - Fax:
Practice Address - Street 1:1901 SOUTH ST
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55812-2116
Practice Address - Country:US
Practice Address - Phone:218-727-3789
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND117601223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics