Provider Demographics
NPI:1487994406
Name:KATHLEEN CARSON DDS, INC
Entity type:Organization
Organization Name:KATHLEEN CARSON DDS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:CARSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-889-0400
Mailing Address - Street 1:30200 AGOURA RD
Mailing Address - Street 2:SUITE 270
Mailing Address - City:AGOURA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91301-5434
Mailing Address - Country:US
Mailing Address - Phone:818-889-0400
Mailing Address - Fax:818-889-9032
Practice Address - Street 1:30200 AGOURA RD
Practice Address - Street 2:SUITE 270
Practice Address - City:AGOURA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91301-5434
Practice Address - Country:US
Practice Address - Phone:818-889-0400
Practice Address - Fax:818-889-9032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-28
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332BC3200X
CA48708122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized EquipmentGroup - Single Specialty