Provider Demographics
NPI:1821498858
Name:SARAH L CARLSON DDS PA
Entity Type:Organization
Organization Name:SARAH L CARLSON DDS PA
Other - Org Name:NORTHSTAR DENTAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:CARLSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:651-472-4713
Mailing Address - Street 1:350 MAIN ST N UNIT 404
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:MN
Mailing Address - Zip Code:55082-6755
Mailing Address - Country:US
Mailing Address - Phone:651-472-4713
Mailing Address - Fax:
Practice Address - Street 1:675 E NICOLLET BLVD STE 120
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-6748
Practice Address - Country:US
Practice Address - Phone:952-892-7700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-27
Last Update Date:2014-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND121151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty