Basic Information
| Provider Information | |||||||||
| NPI: | 1750494498 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CARLSON | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | BRUCE | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 220 SUNBIRD CLIFFS LN | ||||||||
| Address2: | |||||||||
| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809198015 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 220 SUNBIRD CLIFFS LN | ||||||||
| Address2: | |||||||||
| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809198015 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7195265537 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/16/2006 | ||||||||
| LastUpdateDate: | 02/27/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | 173 | CO | N | Dental Providers | Dentist | General Practice | 1223G0001X | DEN-173 | CO | N | Dental Providers | Dentist | General Practice | 1223P0700X | DEN-173 | CO | N | Dental Providers | Dentist | Prosthodontics | 1223G0001X | 019-14025 | IL | N | Dental Providers | Dentist | General Practice | 1223G0001X | DEN......173 | CO | Y | Dental Providers | Dentist | General Practice |
No ID Information.