Kerry Carlson DDS,PLLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

KERRY CARLSON DDS,PLLC

Doing business as

Blue Skye Dental

Practice address

1619 W Main St Ste a
Clarksville, AR 72830-3225

Phone

(479) 754-2042

Fax

(479) 754-2429

NPI assigned

Oct 28, 2020

Organization subpart

No

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

Authorized official

Name

Jennifer D Ihle

Title

Business Administrator

Phone

(479) 754-2042

Specialties & licenses 1

Addresses

Other names 2

• Blue Skye Dental Doing business as
• Kerry Carlson DDS,PLLC Former legal business name

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kerry S. Carlson, DDS

  • General Practice Dentistry
  • Clarksville, AR
  • NPI 1881665206
  NPD
• Timothy R Ward, DMD

  • Dentist
  • Clarksville, AR
  • NPI 1427080688
  NPD (past)

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

{
    "created_epoch": "1603843200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1603843200000",
    "number": "1568062685",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1619 W MAIN ST STE A",
            "city": "CLARKSVILLE",
            "state": "AR",
            "postal_code": "728303225",
            "telephone_number": "479-754-2042"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1619 W MAIN ST STE A",
            "city": "CLARKSVILLE",
            "state": "AR",
            "postal_code": "728303225",
            "telephone_number": "479-754-2042",
            "fax_number": "479-754-2429"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KERRY CARLSON DDS,PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-10-28",
        "last_updated": "2020-10-28",
        "certification_date": "2020-10-28",
        "status": "A",
        "authorized_official_last_name": "IHLE",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "BUSINESS ADMINISTRATOR",
        "authorized_official_telephone_number": "479-754-2042"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Blue Skye Dental",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Kerry Carlson DDS,PLLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Camille Judy
• Brooklynn Justice, RECOVERY ASSISTANT
• Erika Keene, CMP
• Roger O Kennedy, CRNA
• Robert Terry Kerbs, D.C., C.C.E.P.
• Deanna Keylon
• Rebecca Keylon
• Derek Killane
• Amanda Kimbrough
• Josh Kimes, RECOVERY ASSISTANT

• Dental Clinic/Center in Clarksville, AR
• Providers in Clarksville, AR by specialty
• Dental Clinic/Center in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2020; 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.