Carlson Dental Group Providers, LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DN19024 Issued in FL

Legal business name

CARLSON DENTAL GROUP PROVIDERS, LLC

Practice address

13241 Bartram Park Blvd
BLDG 1700
Jacksonville, FL 32258-5212

Phone

(904) 262-8409

Fax

(904) 262-4012

NPI assigned

Sep 4, 2013

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Richard Dean Carlson, DMD

Title

Owner

Phone

(904) 262-8409

Specialties & licenses 3

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1378252800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1378252800000",
    "number": "1265867691",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13241 BARTRAM PARK BLVD",
            "address_2": "BLDG 1700",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322585212",
            "telephone_number": "904-262-8409",
            "fax_number": "904-262-4012"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13241 BARTRAM PARK BLVD",
            "address_2": "BLDG 1700",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322585212",
            "telephone_number": "904-262-8409",
            "fax_number": "904-262-4012"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CARLSON DENTAL GROUP PROVIDERS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-09-04",
        "last_updated": "2013-09-04",
        "status": "A",
        "authorized_official_last_name": "CARLSON",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_middle_name": "DEAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "904-262-8409",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "DN19024",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "DN20275",
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "FL",
            "license": "DN18532",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rachael L Carloni, PHARM.D.
• Carlos Torrellas MD, LLC
• Perry G Carlos, DO
• Sabrina Carlough
• Priscilla Carlsgaard, MS
• Carlson Dental Group Riverside, PA
• Carlson Health Promotion
• Dianna Carlson-Bright
• Aleia Carlson, OTD, OTR/L
• David Nylas Carlson, D.O.

• General Practice Dentistry in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• General Practice Dentistry in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.