Organization
VERIMAX
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN CARSON DDS (OWNER)
(313) 213-3186
Entity
Organization
Contact information
Practice address
5731 ALLEN RD, ALLEN PARK, MI 48101-2605
(313) 253-0450
(313) 908-4146
Mailing address
3229 STUART LN, DEARBORN, MI 48120-1358
(313) 213-3186
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1871654012
—
MI
Enumeration date
12/14/2021
Last updated
12/14/2021
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