Individual
DR. JAN RAY CARLSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
133 E FAIRMOUNT AVE STE 1, LAKEWOOD, NY 14750-1950
(716) 763-0130
Mailing address
133 E FAIRMOUNT AVE STE 1, LAKEWOOD, NY 14750-1950
(716) 763-0130
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
058246
NY
1223P0221X
Pediatric Dentistry
60345
KS
Other
Enumeration date
09/01/2006
Last updated
07/28/2016
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