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General NPI Number Information
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NPI Number | 1184637258
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Entity Type | Organization
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Legal Business Name | CARLSON DENTAL OFFICE PA
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Dates
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Enumeration Date | 08/13/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 717 S STATE ST STE 700
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City | FAIRMONT
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State | MN
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Zip | 56031-4469
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Country | US
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Telephone | 507-238-1883
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Fax | 507-238-1612
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Provider Business Mailing Address
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Address Line | 717 S STATE ST STE 700
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City | FAIRMONT
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State | MN
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Zip | 56031-4469
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Country | US
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Telephone | 507-238-1883
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Fax | 507-238-1612
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Authorized Official
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Title or Position | DENTIST OWNER
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Name | DR. PAUL F CARLSON
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Credential | DDS
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Telephone | 507-238-1883
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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 | 6851
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 11032
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License Number State | MN
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