Healthcare Provider Details

I. General information

NPI: 1043270267
Provider Name (Legal Business Name): RENEE DAWN CARLSON DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 07/13/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIT 6180
APO AE
09604-0245
IT

IV. Provider business mailing address

UNIT 6180
APO AE
09604-0245
IT

V. Phone/Fax

Practice location:
  • Phone: 43-430-5060
  • Fax:
Mailing address:
  • Phone: 43-430-5060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDN 14721
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: