Provider Demographics
NPI:1134172828
Name:CARSON, R CHRISTOPHER (DDS)
Entity type:Individual
Prefix:DR
First Name:R
Middle Name:CHRISTOPHER
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 1:8505 TANGLEWOOD SQ STE T17
Mailing Address - Street 2:
Mailing Address - City:CHAGRIN FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44023-6400
Mailing Address - Country:US
Mailing Address - Phone:440-543-1234
Mailing Address - Fax:440-543-1205
Practice Address - Street 1:8505 TANGLEWOOD SQ STE T17
Practice Address - Street 2:
Practice Address - City:CHAGRIN FALLS
Practice Address - State:OH
Practice Address - Zip Code:44023-6400
Practice Address - Country:US
Practice Address - Phone:440-543-1234
Practice Address - Fax:440-543-1205
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.0208911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2193246Medicaid