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General NPI Number Information
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NPI Number | 1861739898
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Entity Type | Individual
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Provider Name | JAMIE LYNN CARLSON RDH
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Gender | Female
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Dates
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Enumeration Date | 01/10/2013
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Last Update Date | 01/10/2013
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Provider Practice Location Address
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Address Line | 1700 HIGHWAY 36 W SUITE 860
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City | ROSEVILLE
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State | MN
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Zip | 55113-4034
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Country | US
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Telephone | 651-319-5497
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Fax | 651-633-0146
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Provider Business Mailing Address
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Address Line | 1700 WEST HIGHWAY 36 SUITE 860
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City | ROSEVILLE
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State | MN
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Zip | 55113
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Country | US
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Telephone | 651-319-5497
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Fax | 651-633-0146
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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 | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | H6990
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License Number State | MN
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