Provider Demographics
NPI:1669549648
Name:CARSON, KWELI KEENE (DDS)
Entity type:Individual
Prefix:
First Name:KWELI
Middle Name:KEENE
Last Name:CARSON
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 1:3954 BALLET WAY
Mailing Address - Street 2:
Mailing Address - City:BURTONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20866
Mailing Address - Country:US
Mailing Address - Phone:301-476-9527
Mailing Address - Fax:301-604-3600
Practice Address - Street 1:7625 MAPLE LAWN BLVD
Practice Address - Street 2:SUITE 255
Practice Address - City:FULTON
Practice Address - State:MD
Practice Address - Zip Code:20759-2565
Practice Address - Country:US
Practice Address - Phone:301-604-3636
Practice Address - Fax:301-604-3600
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2010-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD12155122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist