Kerry S. Carlson, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

6583 Issued in KS

Practice address

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

Phone

(479) 754-2042

Fax

(479) 754-2429

NPI assigned

Feb 1, 2006

Last updated

Oct 28, 2020By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Kerry Carlson DDS,PLLC

  dba Blue Skye Dental

  • Dental Clinic/Center
  • Clarksville, AR
  • NPI 1568062685
  NPD

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

{
    "created_epoch": "1138752000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603843200000",
    "number": "1881665206",
    "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",
            "fax_number": "479-754-2429"
        },
        {
            "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": {
        "last_name": "CARLSON",
        "first_name": "KERRY",
        "middle_name": "S.",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-02-01",
        "last_updated": "2020-10-28",
        "certification_date": "2020-09-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "KS",
            "license": "6583",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• D'Aundra Cain
• Samantha Jo Cambell
• Diana Carillo-Medina, RECOVERY ASSISTANT
• Charlene Carlie, MHPP
• Neshaune Carlie
• Sarah Casey, CMP
• De'Ericka Celestre, MASSAGE
• Jessica Chandler, QBHP
• Chatterbug Therapies, Inc
• Chatterbug Therapies, Inc.

• General Practice Dentistry in Clarksville, AR
• Providers in Clarksville, AR by specialty
• General Practice Dentistry 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.