Healthcare Provider Details

I. General information

NPI: 1457270407
Provider Name (Legal Business Name): CAMERON DANIEL CARLSON DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7154 MAGNOLIA AVE
RIVERSIDE CA
92504-3804
US

IV. Provider business mailing address

740 E SUNSET DR N
REDLANDS CA
92373-7650
US

V. Phone/Fax

Practice location:
  • Phone: 951-686-3666
  • Fax:
Mailing address:
  • Phone: 909-499-5332
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number113147
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: