Provider Demographics
NPI:1851131007
Name:KELSO, CARSON SETH (DMD)
Entity type:Individual
Prefix:DR
First Name:CARSON
Middle Name:SETH
Last Name:KELSO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2066 FALL RIVER RD
Mailing Address - Street 2:
Mailing Address - City:LEOMA
Mailing Address - State:TN
Mailing Address - Zip Code:38468-5036
Mailing Address - Country:US
Mailing Address - Phone:931-242-9964
Mailing Address - Fax:
Practice Address - Street 1:1620 BUSINESS AVE
Practice Address - Street 2:
Practice Address - City:LAWRENCEBURG
Practice Address - State:TN
Practice Address - Zip Code:38464-2398
Practice Address - Country:US
Practice Address - Phone:931-762-1975
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-27
Last Update Date:2024-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN12499122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist