MEDICARE: DR. LISA CARLSON-MARKS D.D.S.

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
1	1223P0221X	Pediatric Dentistry	7396	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1952301582
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LISA CARLSON-MARKS D.D.S.

Provider Business Mailing Address
First Line	:	2556 S CLAYTON ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80210-6115
Country	:	US
Telephone Number	:	303-377-1148
Fax Number	:	303-388-2142

Provider Business Practice Location Address
First Line	:	4500 CHERRY CREEK SOUTH DR
Second Line	:	# 840
City	:	GLENDALE
State	:	CO
Zip	:	80246-1518
Country	:	US
Telephone Number	:	303-377-1148
Fax Number	:	303-388-2142

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/26/2005
Last Update Date	:	05/16/2012

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