Healthcare Provider Details

I. General information

NPI: 1316864721
Provider Name (Legal Business Name): CARLSON DENTAL HOLDINGS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1825 SUNSET POINT RD
CLEARWATER FL
33765-1024
US

IV. Provider business mailing address

1825 SUNSET POINT RD
CLEARWATER FL
33765-1024
US

V. Phone/Fax

Practice location:
  • Phone: 727-888-6523
  • Fax:
Mailing address:
  • Phone: 727-888-6523
  • 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. NICOLE ANNA CARLSON
Title or Position: DENTIST
Credential: DDS
Phone: 727-510-5157