Healthcare Provider Details

I. General information

NPI: 1467316224
Provider Name (Legal Business Name): DR. KATHLEEN CARSON, DENTAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20271 SW ACACIA ST STE 100
NEWPORT BEACH CA
92660-1731
US

IV. Provider business mailing address

690 BLUEBIRD CANYON DR
LAGUNA BEACH CA
92651-3301
US

V. Phone/Fax

Practice location:
  • Phone: 949-274-9287
  • Fax:
Mailing address:
  • Phone: 805-504-5508
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. KATHLEEN CARSON
Title or Position: OWNER
Credential: DDS
Phone: 805-504-5508