NPI Code Detail JSON Logo

1073214136 NPI number — KAITLIN MARIE CARLSON DMD

NPI Number: 1073214136
Health Care Provider/Practitioner: KAITLIN MARIE CARLSON DMD

Information about “1073214136” NPI (KAITLIN MARIE CARLSON DMD) exists in 1073214136 in HTML format HTML  |  1073214136 in plain Text format TXT  |  1073214136 in PDF (Portable Document Format) PDF  |  1073214136 in an XML format XML  formats.

NPI Number : 1073214136 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1073214136",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "CARLSON",
    "FirstName": "KAITLIN",
    "MiddleName": "MARIE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "DMD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "13116 FAWN CREEK RD",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "HIGHLAND",
    "MailingAddressStateName": "IL",
    "MailingAddressPostalCode": "62249-2828",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "618-975-4876",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "2401 GILLHAM RD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "KANSAS CITY",
    "PracticeLocationAddressStateName": "MO",
    "PracticeLocationAddressPostalCode": "64108-4619",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "816-234-3000",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "03/15/2023",
    "LastUpdateDate": "07/08/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "1223P0221X",
        "TaxonomyName": "Pediatric Dentistry",
        "LicenseNumber": "019.035868",
        "LicenseNumberStateCode": "IL",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

Copyright © 2007-2026 Data Labs Health. All rights reserved.