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General NPI Number Information
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NPI Number | 1043838774
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Entity Type | Individual
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Provider Name | JENNIFER MARIE CARLSON DMD
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Gender | Female
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Dates
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Enumeration Date | 07/09/2020
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Last Update Date | 07/09/2020
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Provider Practice Location Address
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Address Line | 2101 ASPEN DR
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City | MECHANICSBURG
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State | PA
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Zip | 17055-5508
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Country | US
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Telephone | 717-697-3400
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Fax |
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Provider Business Mailing Address
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Address Line | 412 MAYER PL
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City | LANCASTER
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State | PA
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Zip | 17601-3988
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DS042802
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License Number State | PA
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