Provider Demographics
NPI:1639291644
Name:CARLSON, ROY W (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROY
Middle Name:W
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 1:21616 76TH AVE W
Mailing Address - Street 2:SUITE 204
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-7512
Mailing Address - Country:US
Mailing Address - Phone:425-775-2521
Mailing Address - Fax:425-771-7171
Practice Address - Street 1:21616 76TH AVE W
Practice Address - Street 2:SUITE 204
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-7512
Practice Address - Country:US
Practice Address - Phone:425-775-2521
Practice Address - Fax:425-771-7171
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA39081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice