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NPI Code Detail

MEDICARE: DR. SARAH JANE FRAILEY CARLSON DDS

MEDICARE: DR. SARAH JANE FRAILEY CARLSON DDS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1122300000XDentistIL

General Provider Information

NPI Number : 1154477578
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SARAH JANE FRAILEY CARLSON DDS
Provider Business Mailing Address
First Line : 2351 W HARRISON ST
Second Line : #3
City : CHICAGO
State : IL
Zip : 60612-3677
Country : US
Telephone Number : 312-479-1977
Fax Number :
Provider Business Practice Location Address
First Line : 2316 W MADISON ST
Second Line :
City : CHICAGO
State : IL
Zip : 60612-2228
Country : US
Telephone Number : 312-491-0601
Fax Number : 312-491-0602
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/26/2007
Last Update Date : 07/08/2007

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