Individual
DR. RUSSELL EDGAR CARLSON III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1145 66TH ST, SUITE 2, WINDSOR HEIGHTS, IA 50311-1705
(515) 279-0856
(515) 255-6907
Mailing address
1145 66TH ST, SUITE 2, WINDSOR HEIGHTS, IA 50311-1705
(515) 279-0856
(515) 255-6907
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
6535
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500058
—
IA
Enumeration date
04/23/2008
Last updated
04/23/2008
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