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General NPI Number Information
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NPI Number | 1497818652
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Entity Type | Individual
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Provider Name | JULIA E. CARLSON D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 12/19/2006
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Last Update Date | 09/29/2020
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Provider Practice Location Address
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Address Line | 2580 KIOWA BLVD N
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City | LAKE HAVASU CITY
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State | AZ
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Zip | 86403-2551
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Country | US
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Telephone | 928-566-4791
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Fax | 928-566-4791
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Provider Business Mailing Address
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Address Line | 2580 KIOWA BLVD N
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City | LAKE HAVASU CITY
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State | AZ
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Zip | 86403-2551
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Country | US
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Telephone | 928-566-4791
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Fax | 928-566-4793
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 37197
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License Number State | CA
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