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Organization
CARSON FAMILY DENTISTRY, PROF LLC
Active
Organization
CARSON FAMILY DENTISTRY, PROF LLC
Active
Other names
Carson Family Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CL;ARENCE NOLAN CARSON III DDS (OWNER, DENTIST)
(605) 369-2226
Entity
Organization
Contact information
Practice address
707 CHESTNUT ST, BOX 567, SPRINGFIELD, SD 57062
(605) 369-2226
Mailing address
707 CHESTNUT ST, BOX 567, SPRINGFIELD, SD 57062
(605) 369-2226
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
M894
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1528154234
—
NE
Enumeration date
07/27/2012
Last updated
07/27/2012
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