| Carlson Distinctive Dentistry, Pllc | |
|
1701 Curve Crest Blvd W Ste 100 Stillwater MN 55082 | |
| (651) 439-8840 | |
| Not Available |
| Full Name | Carlson Distinctive Dentistry, Pllc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 1701 Curve Crest Blvd W Ste 100, Stillwater, Minnesota |
| Authorized Official Name and Position | Sarah L Carlson (PRESIDENT/CEO) |
| Authorized Official Contact | 6514724713 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Carlson Distinctive Dentistry, Pllc 6332 Paris Ave N Stillwater MN 55082-6828 Ph: (651) 472-4713 | Carlson Distinctive Dentistry, Pllc 1701 Curve Crest Blvd W Ste 100 Stillwater MN 55082 Ph: (651) 439-8840 |
| NPI Number | 1598243990 |
|---|---|
| Provider Enumeration Date | 07/30/2018 |
| Last Update Date | 03/07/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1598243990 | NPI | - | NPPES |
| 6847-15 | Other | WI | WI DENTAL BOARD |
| D12115 | Other | MN | MN BOARD OF DENTISTRY |
| 1306976279 | Other | NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | D12115 (Minnesota) | Primary |
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