Provider Demographics
NPI:1194738617
Name:CARSON, THOMAS L (DDS)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:L
Last Name:CARSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 OAKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27517-5652
Mailing Address - Country:US
Mailing Address - Phone:919-967-0453
Mailing Address - Fax:
Practice Address - Street 1:321 S ACADEMY ST
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-3304
Practice Address - Country:US
Practice Address - Phone:919-467-7360
Practice Address - Fax:919-467-0602
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC73471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice