Provider Demographics
NPI:1437677101
Name:CARLSON, MICHELLE COLLEEN (RDH)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:COLLEEN
Last Name:CARLSON
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:348 PARKWAY S
Mailing Address - Street 2:
Mailing Address - City:BREWER
Mailing Address - State:ME
Mailing Address - Zip Code:04412-1720
Mailing Address - Country:US
Mailing Address - Phone:207-745-6615
Mailing Address - Fax:
Practice Address - Street 1:2402 ROUTE 2 STE E
Practice Address - Street 2:
Practice Address - City:HERMON
Practice Address - State:ME
Practice Address - Zip Code:04401-0666
Practice Address - Country:US
Practice Address - Phone:207-848-3384
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-01
Last Update Date:2017-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist