Carrie Carlson, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D12060 Issued in MN

Practice address

505 Johnson Ave SE
Pine City, MN 55063-2108

Phone

(320) 629-2282

NPI assigned

Jan 28, 2006

Last updated

Dec 5, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1138406400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1670198400000",
    "number": "1568433563",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "505 JOHNSON AVE SE",
            "city": "PINE CITY",
            "state": "MN",
            "postal_code": "550632108",
            "telephone_number": "320-629-2282"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "505 JOHNSON AVE SE",
            "city": "PINE CITY",
            "state": "MN",
            "postal_code": "550632108",
            "telephone_number": "320-629-2282"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARLSON",
        "first_name": "CARRIE",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-01-28",
        "last_updated": "2022-12-05",
        "certification_date": "2022-12-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "D12060",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "328608800",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Larry Brackenbury
• Rebecca Ann Broz
• Kelly Ann Buchta, MSW, LICSW
• Sarah L Busch, LPCC
• Amber L Callahan, PHARMD.
• Kathleen A Caron, LICSW
• Sarah Marie Carpenter
• Kristen Christopherson, ATC
• Holly Elizabeth Clark, MSW, LICSW
• Bethany Renee Cleary, MA, LPCC

• General Practice Dentistry in Pine City, MN
• Providers in Pine City, MN by specialty
• General Practice Dentistry in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.