Carlson Dental Group Riverside, PA

Primary specialty

DentistTaxonomy code 122300000X

License

10002 Issued in FL

Legal business name

CARLSON DENTAL GROUP RIVERSIDE, PA

Practice address

501 Riverside Ave
Suite 104
Jacksonville, FL 32202-4934

Phone

(904) 262-8409

Fax

(904) 262-4012

NPI assigned

Apr 22, 2015

Organization subpart

No

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

Authorized official

Name

Barbara Kauffman

Title

Office Manager

Phone

(904) 262-8409

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1429660800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1429660800000",
    "number": "1801283387",
    "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": "501 RIVERSIDE AVE",
            "address_2": "SUITE 104",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322024934",
            "telephone_number": "904-262-8409",
            "fax_number": "904-262-4012"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CARLSON DENTAL GROUP RIVERSIDE, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-04-22",
        "last_updated": "2015-04-22",
        "status": "A",
        "authorized_official_last_name": "KAUFFMAN",
        "authorized_official_first_name": "BARBARA",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "904-262-8409"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "FL",
            "license": "10002",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DENTAL LICENSE NUMBER",
            "identifier": "10002",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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

• Dentist in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Dentist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2015; 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.