MEDICARE: DR. JOHN H CARSON DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	11710	MI

General Provider Information

NPI Number	:	1871654012
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN H CARSON DDS

Provider Business Mailing Address
First Line	:	3320 WISCASSET RD
Second Line	:	APT #206
City	:	DEARBORN
State	:	MI
Zip	:	48120-1198
Country	:	US
Telephone Number	:	313-271-0376
Fax Number	:

Provider Business Practice Location Address
First Line	:	18424 W MCNICHOLS RD
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48219-4161
Country	:	US
Telephone Number	:	313-537-3800
Fax Number	:	313-537-2080

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/12/2006
Last Update Date	:	07/08/2007

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Directions to “ DR. JOHN H CARSON DDS” Practice Location

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