Individual
BRIAN CARLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
1060 MCKINLEY MALL, BLASDELL, NY 14219
(716) 954-8705
Mailing address
1060 MCKINLEY MALL, BLASDELL, NY 14219-3019
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
060288
NY
122300000X
Dentist
DS040995
PA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/04/2016
Last updated
04/29/2019
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