Individual
CARRIE CARLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
505 JOHNSON AVE SE, PINE CITY, MN 55063-2108
(320) 629-2282
Mailing address
505 JOHNSON AVE SE, PINE CITY, MN 55063-2108
(320) 629-2282
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D12060
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
328608800
—
MN
Enumeration date
01/28/2006
Last updated
12/05/2022
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