Healthcare Provider Details

I. General information

NPI: 1508986779
Provider Name (Legal Business Name): CHRISTOPHER PAUL CARLSON DMD, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2007
Last Update Date: 07/10/2025
Certification Date: 07/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 S 29TH AVE
BOZEMAN MT
59718-4220
US

IV. Provider business mailing address

1901 SOUTH ST
DULUTH MN
55812-2116
US

V. Phone/Fax

Practice location:
  • Phone: 406-587-1811
  • Fax:
Mailing address:
  • Phone: 218-727-3789
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberD11760
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: