Healthcare Provider Details

I. General information

NPI: 1861665499
Provider Name (Legal Business Name): EDWARD H. CARLSON DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2008
Last Update Date: 04/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6755 E SUPERSTITION SPRINGS BLVD STE 101
MESA AZ
85206-4375
US

IV. Provider business mailing address

6755 E SUPERSTITION SPRINGS BLVD STE 101
MESA AZ
85206-4375
US

V. Phone/Fax

Practice location:
  • Phone: 480-807-8022
  • Fax: 480-807-5955
Mailing address:
  • Phone: 480-807-8022
  • Fax: 480-807-5955

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number3663
License Number StateAZ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: