Individual
DR. MARK DAVID CARLSON
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
MS DDS
Contact information
Practice address
1550 SOUTH UNION AVENUE, SUITE 250, TACOMA, WA 98405-1946
(253) 572-4601
(253) 572-4769
Mailing address
1550 SOUTH UNION AVENUE, SUITE 250, TACOMA, WA 98405-1946
(253) 572-4601
(253) 572-4769
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
DE00005551
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5005491
—
WA
Enumeration date
04/22/2006
Last updated
07/08/2007
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