Carlson, Russell Edgar

Carlson, Russell Edgar is an individual health care provider with primary practice located at 1145 66Th St Suite 2, Windsor Heights IA 50311-1705. He recently has only one registered license in Dental Providers / General Practice, which is considered as his primary health care specialty. Carlson, Russell Edgar can be contacted via phone (515) 279-0856.

Contact Information

Primary practice address
1145 66Th St Suite 2 Windsor Heights IA 50311-1705
Phone: (515) 279-0856
Fax: (515) 255-6907
Website:
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Health care specialties

SpecialtyCodeLicense #State
Dental Providers / General Practice 1223G0001X 6535 Iowa

Profile Details

NPI number 1164697066
LBN Legal business name Carlson, Russell Edgar
Credentials Doctor of Dental Surgery (DDS)
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 23rd, 2008
Last updated Apr 23rd, 2008 - about 18 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1164697066 NPPES
Iowa MEDICAID 500058

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