Organization
CARLSON DENTAL GROUP PROVIDERS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RICHARD DEAN CARLSON DMD (OWNER)
(904) 262-8409
Entity
Organization
Contact information
Practice address
13241 BARTRAM PARK BLVD, BLDG 1700, JACKSONVILLE, FL 32258-5212
(904) 262-8409
(904) 262-4012
Mailing address
13241 BARTRAM PARK BLVD, BLDG 1700, JACKSONVILLE, FL 32258-5212
(904) 262-8409
(904) 262-4012
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DN19024
FL
1223G0001X
General Practice Dentistry
DN20275
FL
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
DN18532
FL
Other
Enumeration date
09/04/2013
Last updated
09/04/2013
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