Provider Demographics
NPI:1669854113
Name:CARLON, CHRISTEN MARYANN (DMD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTEN
Middle Name:MARYANN
Last Name:CARLON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1105 W 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31707-3622
Mailing Address - Country:US
Mailing Address - Phone:229-883-1123
Mailing Address - Fax:
Practice Address - Street 1:1105 W 4TH AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31707-3622
Practice Address - Country:US
Practice Address - Phone:229-883-1123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-22
Last Update Date:2015-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN014981122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist