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General NPI Number Information
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NPI Number | 1568527703
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Entity Type | Individual
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Provider Name | GARY DAVID CARLSEN DDS
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Gender | Male
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Dates
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Enumeration Date | 12/27/2006
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Last Update Date | 02/23/2009
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Provider Practice Location Address
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Address Line | 17822 BEACH BLVD STE 342
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City | HUNTINGTON BEACH
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State | CA
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Zip | 92647-7518
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Country | US
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Telephone | 714-847-6044
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Fax | 714-842-3145
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Provider Business Mailing Address
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Address Line | 17822 BEACH BLVD STE 342
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City | HUNTINGTON BEACH
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State | CA
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Zip | 92647-7518
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Country | US
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Telephone | 714-847-6044
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Fax | 714-842-3145
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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 | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 21856
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License Number State | CA
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