Eric Todd Carlson, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D12093 Issued in MN

Practice address

12725 43Rd St NE Ste 202
Saint Michael, MN 55376-4929

Phone

(763) 497-2367

Fax

(763) 497-8171

NPI assigned

Dec 6, 2006

Last updated

Jan 6, 2012By 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

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

Practice roles

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.

• Northwest Family Dental Center TN

  • General Practice Dentistry
  • Saint Michael, MN
  • NPI 1114130010
  NPD (past)

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

{
    "created_epoch": "1165363200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1325808000000",
    "number": "1902965890",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12725 43RD ST NE STE 202",
            "city": "SAINT MICHAEL",
            "state": "MN",
            "postal_code": "553764929",
            "telephone_number": "763-497-2367",
            "fax_number": "763-497-8171"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12725 43RD ST NE STE 202",
            "city": "SAINT MICHAEL",
            "state": "MN",
            "postal_code": "553764929",
            "telephone_number": "763-497-2367",
            "fax_number": "763-497-8171"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARLSON",
        "first_name": "ERIC",
        "middle_name": "TODD",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-12-06",
        "last_updated": "2012-01-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "D12093",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "58492400",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Richard John Budde
• Renee C Burk, FNP
• Laura Byer, LICSW
• Emma Bylund
• Alexandria Grace Cady
• Julia Rose Carlson
• Kimberly Ann Carlson, CMT
• Jennifer Cepress, MA
• Choice Chiropractic, Inc
• Nicoline Chomilo

• General Practice Dentistry in Saint Michael, MN
• Providers in Saint Michael, 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 Jan 6, 2012; 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.