Provider Demographics
NPI:1386729812
Name:CARLSON, VANCE DOUGLAS (DDS)
Entity type:Individual
Prefix:
First Name:VANCE
Middle Name:DOUGLAS
Last Name:CARLSON
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 1:7325 S PIERCE ST SUITE 200
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80128
Mailing Address - Country:US
Mailing Address - Phone:303-932-6018
Mailing Address - Fax:303-978-9152
Practice Address - Street 1:7325 S PIERCE ST SUITE 200
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80128
Practice Address - Country:US
Practice Address - Phone:303-932-6018
Practice Address - Fax:303-978-9152
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1052721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice