Provider Demographics
NPI:1255935359
Name:CARLSON, JADE CATHERINE (DDS)
Entity type:Individual
Prefix:
First Name:JADE
Middle Name:CATHERINE
Last Name:CARLSON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:JADE
Other - Middle Name:CATHERINE
Other - Last Name:NIX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:2925 OAK PARK CIR STE 100
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76109-1867
Mailing Address - Country:US
Mailing Address - Phone:817-732-5522
Mailing Address - Fax:
Practice Address - Street 1:2925 OAK PARK CIR STE 100
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76109-1867
Practice Address - Country:US
Practice Address - Phone:817-732-5522
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-30
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX368771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice