Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | DN 14721 | FL |
NPI | 1043270267 |
---|---|
Provider Name | Dr. Renee Dawn Carlson |
First Address | Apo, AE 09604-0245 |
Second Address | Apo, AE 09604-0245 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/03/2006 |
Last Update Date | 08/07/2007 |