Provider Demographics
NPI:1972798015
Name:CARLSON, MATTHEW E (DDS)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:E
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 1:130 S 15TH ST STE 101
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98274-4569
Mailing Address - Country:US
Mailing Address - Phone:360-428-4393
Mailing Address - Fax:
Practice Address - Street 1:130 S 15TH ST STE 101
Practice Address - Street 2:NORTH SOUND ENDODONTCS
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98274-4569
Practice Address - Country:US
Practice Address - Phone:360-428-4393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-12
Last Update Date:2024-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000110231223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics