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Organization
RANDY D CARLSON DMD ADC AND CHARLES L DRURY DDS AEGD APC
Active
Organization
RANDY D CARLSON DMD ADC AND CHARLES L DRURY DDS AEGD APC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RANDY DENNIS CARLSON DMD (MANAGING PARTNER)
(760) 630-5500
Entity
Organization
Contact information
Practice address
5256 S MISSION RD, SUITE 1101, BONSALL, CA 92003-3614
(760) 630-5500
(760) 630-5831
Mailing address
5256 S MISSION RD, SUITE 1101, BONSALL, CA 92003-3614
(760) 630-5500
(760) 630-5831
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
34679
CA
1223G0001X
General Practice Dentistry
48905
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
34679
DELTA DENTAL
CA
01
—
415674
UNITED CONCORDIA
CA
01
—
48905
DELTA DENTAL
CA
01
—
753898
UNITED CONCORDIA
CA
Enumeration date
01/21/2011
Last updated
01/21/2011
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