Organization
SCOTT D CARLSON
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GERALYN MARY BERENS (OFFICE MANAGER)
(952) 447-6054
Entity
Organization
Contact information
Practice address
4667 DAKOTA ST SE, PRIOR LAKE, MN 55372-1714
(952) 447-6054
(952) 447-6139
Mailing address
4667 DAKOTA ST SE, PRIOR LAKE, MN 55372-1714
(952) 447-6054
(952) 447-6139
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
07/30/2020
Last updated
07/30/2020
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