Provider Demographics
NPI:1891834081
Name:CARSON, BRAD WILLIAM (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRAD
Middle Name:WILLIAM
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 1:7605 PACIFIC ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-5420
Mailing Address - Country:US
Mailing Address - Phone:402-390-8619
Mailing Address - Fax:402-502-9201
Practice Address - Street 1:7605 PACIFIC ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-5420
Practice Address - Country:US
Practice Address - Phone:402-390-8619
Practice Address - Fax:402-502-9201
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE5634122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist