Provider Demographics
NPI:1952301582
Name:CARLSON-MARKS, LISA (DDS)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:
Last Name:CARLSON-MARKS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2556 S CLAYTON ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80210-6115
Mailing Address - Country:US
Mailing Address - Phone:303-377-1148
Mailing Address - Fax:303-388-2142
Practice Address - Street 1:4500 CHERRY CREEK SOUTH DR
Practice Address - Street 2:# 840
Practice Address - City:GLENDALE
Practice Address - State:CO
Practice Address - Zip Code:80246-1518
Practice Address - Country:US
Practice Address - Phone:303-377-1148
Practice Address - Fax:303-388-2142
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO73961223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO71905774Medicaid
CO55931375Medicaid