Individual
DOMINIC GORDON CARLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
105267
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
105267
DENTAL BOARD OF CALIFORNIA
CA
Enumeration date
08/31/2020
Last updated
08/31/2020
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