Provider Demographics
NPI:1700830619
Name:CARSON, JENNIE J (DDS)
Entity Type:Individual
Prefix:DR
First Name:JENNIE
Middle Name:J
Last Name:CARSON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:JENNIE
Other - Middle Name:JO
Other - Last Name:HELM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:1035 1ST AVE WEST
Mailing Address - Street 2:FLATHEAD COMMUNITY HEALTH CENTER
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-5607
Mailing Address - Country:US
Mailing Address - Phone:406-751-8113
Mailing Address - Fax:406-751-8151
Practice Address - Street 1:1035 1ST AVE WEST
Practice Address - Street 2:FLATHEAD COMMUNITY HEALTH CENTER
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-5607
Practice Address - Country:US
Practice Address - Phone:406-751-8113
Practice Address - Fax:406-751-8151
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2012-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT2304122300000X
AZ62801223G0001X
WA75361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice