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Organization
CARLSON DISTINCTIVE DENTISTRY, PLLC
Active
Organization
CARLSON DISTINCTIVE DENTISTRY, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SARAH L CARLSON DDS (PRESIDENT/CEO)
(651) 472-4713
Entity
Organization
Contact information
Practice address
1701 CURVE CREST BLVD W STE 100, STILLWATER, MN 55082
(651) 439-8840
Mailing address
6332 PARIS AVE N, STILLWATER, MN 55082-6828
(651) 472-4713
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D12115
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1306976279
NPI
—
01
—
6847-15
WI DENTAL BOARD
WI
01
—
D12115
MN BOARD OF DENTISTRY
MN
Enumeration date
07/30/2018
Last updated
03/07/2023
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