Provider Demographics
NPI:1811999865
Name:CARLSON, CRAIG R (DDS)
Entity type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:R
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 1:400 N LOOP 1604 E
Mailing Address - Street 2:STE 315
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-1200
Mailing Address - Country:US
Mailing Address - Phone:210-494-3511
Mailing Address - Fax:210-494-7115
Practice Address - Street 1:400 N LOOP 1604 E
Practice Address - Street 2:STE 315
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232-1200
Practice Address - Country:US
Practice Address - Phone:210-494-3511
Practice Address - Fax:210-494-7115
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX87531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice