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General NPI Number Information
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NPI Number | 1366835019
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Entity Type | Organization
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Legal Business Name | DR. DANIEL W. CARLSON D.D.S., DENTISTRY INC.
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Dates
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Enumeration Date | 03/05/2015
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Last Update Date | 03/05/2015
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Provider Practice Location Address
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Address Line | 102 22ND AVE S
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City | BROOKINGS
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State | SD
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Zip | 57006-2654
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Country | US
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Telephone | 605-697-6212
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Fax |
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Provider Business Mailing Address
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Address Line | 22089 471ST AVE
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City | BROOKINGS
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State | SD
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Zip | 57006-7139
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Country | US
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Telephone | 605-695-3117
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Fax |
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Authorized Official
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Title or Position | DOCTOR OF DENTAL SURGERY
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Name | DR. DANIELW WILLIAM CARLSON
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Credential | D.D.S.
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Telephone | 605-697-6212
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | M409
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License Number State | SD
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