| Scott D Carlson | |
|
4667 Dakota St Se Prior Lake MN 55372-1714 | |
| (952) 447-6054 | |
| (952) 447-6139 |
| Full Name | Scott D Carlson |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 4667 Dakota St Se, Prior Lake, Minnesota |
| Authorized Official Name and Position | Geralyn Mary Berens (OFFICE MANAGER) |
| Authorized Official Contact | 9524476054 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Scott D Carlson 4667 Dakota St Se Prior Lake MN 55372-1714 Ph: (952) 447-6054 | Scott D Carlson 4667 Dakota St Se Prior Lake MN 55372-1714 Ph: (952) 447-6054 |
| NPI Number | 1700495140 |
|---|---|
| Provider Enumeration Date | 07/30/2020 |
| Last Update Date | 07/30/2020 |
| Certification Date | 07/30/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700495140 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (NU) | Primary |
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