Provider Demographics
NPI:1336347301
Name:CARLSON, CRAIG ERIC (DDS)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:ERIC
Last Name:CARLSON
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 1:344 CERNON ST
Mailing Address - Street 2:
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95688
Mailing Address - Country:US
Mailing Address - Phone:707-447-9339
Mailing Address - Fax:707-447-0169
Practice Address - Street 1:344 CERNON ST
Practice Address - Street 2:
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95688
Practice Address - Country:US
Practice Address - Phone:707-447-9339
Practice Address - Fax:707-447-0169
Is Sole Proprietor?:No
Enumeration Date:2007-07-11
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35848122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist