Healthcare Provider Details

I. General information

NPI: 1346337359
Provider Name (Legal Business Name): DANIEL STEVEN CARSON JR. D.M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 03/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6602 ABERCORN ST
SAVANNAH GA
31405-5848
US

IV. Provider business mailing address

63 W BLUFF DR
SAVANNAH GA
31406-7547
US

V. Phone/Fax

Practice location:
  • Phone: 912-354-3444
  • Fax:
Mailing address:
  • Phone: 843-860-0938
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number4130
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDN014555
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: