Provider Demographics
NPI:1609914415
Name:CARLSON, DONALD P JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:P
Last Name:CARLSON
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:6200 S MCCLINTOCK
Mailing Address - Street 2:STE 8
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-3283
Mailing Address - Country:US
Mailing Address - Phone:480-839-0841
Mailing Address - Fax:480-820-3071
Practice Address - Street 1:6200 S MCCLINTOCK
Practice Address - Street 2:STE 8
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-3283
Practice Address - Country:US
Practice Address - Phone:480-839-0841
Practice Address - Fax:480-820-3071
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ22711223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics