Provider Demographics
NPI:1720677297
Name:CARSON CALDERWOOD PLLC DBA BALLARD DENTISTRY
Entity type:Organization
Organization Name:CARSON CALDERWOOD PLLC DBA BALLARD DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARSON
Authorized Official - Middle Name:
Authorized Official - Last Name:CALDERWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:206-781-9204
Mailing Address - Street 1:7152 WOODSIDE PL SW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98136-2068
Mailing Address - Country:US
Mailing Address - Phone:425-736-3631
Mailing Address - Fax:
Practice Address - Street 1:5456 LEARY AVE NW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98107-4068
Practice Address - Country:US
Practice Address - Phone:206-781-9204
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-11
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty