Provider Demographics
NPI:1134599905
Name:CARLSON, ALEXA (DMD)
Entity type:Individual
Prefix:
First Name:ALEXA
Middle Name:
Last Name:CARLSON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1110 COLLEGE DR STE 108
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58501-1207
Mailing Address - Country:US
Mailing Address - Phone:701-255-0586
Mailing Address - Fax:
Practice Address - Street 1:1110 COLLEGE DR STE 108
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-1207
Practice Address - Country:US
Practice Address - Phone:701-255-0586
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-05
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND2268122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist