Carlson Distinctive Dentistry, PLLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D12115 Issued in MN

Legal business name

CARLSON DISTINCTIVE DENTISTRY, PLLC

Practice address

1701 Curve Crest Blvd W Ste 100
Stillwater, MN 55082

Phone

(651) 439-8840

NPI assigned

Jul 30, 2018

Last updated

Mar 7, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Sarah L Carlson, DDSNPI 1306976279

Title

President/Ceo

Phone

(651) 472-4713

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Sarah L Carlson, D.D.S.

  • General Practice Dentistry
  • Stillwater, MN
  • NPI 1306976279
  NPD Authorized official

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

{
    "created_epoch": "1532908800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678147200000",
    "number": "1598243990",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6332 PARIS AVE N",
            "city": "STILLWATER",
            "state": "MN",
            "postal_code": "550826828",
            "telephone_number": "651-472-4713"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1701 CURVE CREST BLVD W STE 100",
            "city": "STILLWATER",
            "state": "MN",
            "postal_code": "55082",
            "telephone_number": "651-439-8840"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CARLSON DISTINCTIVE DENTISTRY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-07-30",
        "last_updated": "2023-03-07",
        "status": "A",
        "authorized_official_last_name": "CARLSON",
        "authorized_official_first_name": "SARAH",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "651-472-4713",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "D12115",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Canvas Health, Inc.
• Canvas Health, Inc.
• Canvas Health, Inc.
• Laura Capelle, OD
• Caring Corner Counseling
• Suzanne M. Carlson-Shimon, FNP-BC
• Douglas J Carlson, M.D.
• Duane M Carlson, LADC
• Erik Carlson, D.C.
• Erin Carlson, MD

• General Practice Dentistry in Stillwater, MN
• Providers in Stillwater, 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 Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.