# CARSON CALDERWOOD PLLC DBA BALLARD DENTISTRY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1720677297
- **Authorized official:** CARSON CALDERWOOD DDS (SOLE OWNER)
- **Authorized official phone:** (206) 781-9204

## Contact information

- **Practice address:** 5456 LEARY AVE NW, SEATTLE, WA 98107-4068
- **Practice address phone:** (206) 781-9204
- **Mailing address:** 7152 WOODSIDE PL SW, SEATTLE, WA 98136-2068
- **Mailing address phone:** (425) 736-3631

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | NULL | Yes |
| 1223G0001X | General Practice Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 01/11/2021
- **Last updated:** 12/17/2021