Provider Demographics
NPI:1689023129
Name:DR. DAVID C CARLSON D.D.S PC
Entity Type:Organization
Organization Name:DR. DAVID C CARLSON D.D.S PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:C
Authorized Official - Last Name:CARLSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:701-664-2582
Mailing Address - Street 1:111 MAIN ST
Mailing Address - Street 2:PO BOX 758
Mailing Address - City:TIOGA
Mailing Address - State:ND
Mailing Address - Zip Code:58852
Mailing Address - Country:US
Mailing Address - Phone:701-664-2582
Mailing Address - Fax:701-664-2581
Practice Address - Street 1:111 MAIN ST
Practice Address - Street 2:B 758
Practice Address - City:TIOGA
Practice Address - State:ND
Practice Address - Zip Code:58852
Practice Address - Country:US
Practice Address - Phone:701-664-2582
Practice Address - Fax:701-664-2581
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-06
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND17181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty