Provider Demographics
NPI:1871654012
Name:CARSON, JOHN H (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:H
Last Name:CARSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3320 WISCASSET RD
Mailing Address - Street 2:APT #206
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48120-1198
Mailing Address - Country:US
Mailing Address - Phone:313-271-0376
Mailing Address - Fax:
Practice Address - Street 1:18424 W MCNICHOLS RD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48219-4161
Practice Address - Country:US
Practice Address - Phone:313-537-3800
Practice Address - Fax:313-537-2080
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI11710122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist