Provider Demographics
NPI: | 1659554335 |
---|---|
Name: | DANIEL O. CARSON, D.D.S, P.A. |
Entity Type: | Organization |
Organization Name: | DANIEL O. CARSON, D.D.S, P.A. |
Other - Org Name: | LAKE NORMAN DENTAL CENTER |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | OFFICER - TREASURER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | STEPHANIE |
Authorized Official - Middle Name: | H |
Authorized Official - Last Name: | CARSON |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 704-489-1777 |
Mailing Address - Street 1: | PO BOX 340 |
Mailing Address - Street 2: | |
Mailing Address - City: | DENVER |
Mailing Address - State: | NC |
Mailing Address - Zip Code: | 28037-0340 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 704-489-1777 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 510 N. HIGHWAY 16 |
Practice Address - Street 2: | |
Practice Address - City: | DENVER |
Practice Address - State: | NC |
Practice Address - Zip Code: | 28037 |
Practice Address - Country: | US |
Practice Address - Phone: | 704-489-1777 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2007-12-17 |
Last Update Date: | 2008-02-14 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
NC | 8131 | 122300000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 122300000X | Dental Providers | Dentist | Group - Single Specialty |