Provider Demographics
NPI:1760545933
Name:LAWSON, CARLY CHRISTINE (DDS)
Entity Type:Individual
Prefix:DR
First Name:CARLY
Middle Name:CHRISTINE
Last Name:LAWSON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:CARLY
Other - Middle Name:CHRISTINE
Other - Last Name:GROTHE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:405 SIBLEY ST
Mailing Address - Street 2:SUITE 240
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55101-2975
Mailing Address - Country:US
Mailing Address - Phone:651-224-9300
Mailing Address - Fax:651-224-3226
Practice Address - Street 1:405 SIBLEY ST
Practice Address - Street 2:SUITE 240
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55101-2975
Practice Address - Country:US
Practice Address - Phone:651-224-9300
Practice Address - Fax:651-224-3226
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2011-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND12267122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist