MEDICARE: MARK TAGUE 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
1	1223G0001X	General Practice Dentistry	6963	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	9026X	OTHER	BLUE CROSS BLUE SHIELD NC
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	1587738	OTHER	UNITED CONCORDIA

General Provider Information

NPI Number	:	1952418618
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK TAGUE CARLSON DDS

Provider Business Mailing Address
First Line	:	2041 SILAS CREEK PKWY
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27103-5147
Country	:	US
Telephone Number	:	336-777-0303
Fax Number	:	336-777-3448

Provider Business Practice Location Address
First Line	:	1400 WALTER REED RD
Second Line	:	SUITE 200
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28304-4409
Country	:	US
Telephone Number	:	910-864-9884
Fax Number	:

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

Provider Enumeration Date	:	08/25/2006
Last Update Date	:	07/08/2007

Similar Medicare Providers

1861429284 — THOMAS HUGO HAMILTON JR. DDS
Practice Location Address:

1400 WALTER REED RD , SUITE 200
FAYETTEVILLE, NC
28304-4409

Practice Phone: 910-864-9884
Practice Fax: 910-354-1399

1386677961 — BALLANCE & DEROSE DDS PA
Practice Location Address:

1400 WALTER REED RD , SUITE 200
FAYETTEVILLE, NC
28304-4409

Practice Phone: 910-864-9884
Practice Fax:

1952313090 — DR. PAIGE E NANCE DDS
Practice Location Address:

1400 WALTER REED RD , SUITE 200
FAYETTEVILLE, NC
28304-4409

Practice Phone: 910-864-9884
Practice Fax:

1285803197 — RAFAEL RIVERA, JR., DDS, PLLC
Practice Location Address:

1400 WALTER REED RD
FAYETTEVILLE, NC
28304-4409

Practice Phone: 910-864-9884
Practice Fax: 910-354-1399

1528485968 — DR. BINIAM TECLE D.D.S.
Practice Location Address:

1400 WALTER REED RD
FAYETTEVILLE, NC
28304-4409

Practice Phone: 910-864-9884
Practice Fax:

1780515239 — OKISHA DENNA REUBEN
Practice Location Address:

3413 CHRISTAKAIT PL APT D
FAYETTEVILLE, NC
28306-4409

Practice Phone: 910-813-0607
Practice Fax:

Directions to “ MARK TAGUE CARLSON DDS” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.