National Provider Identifier
Jan Ray Carlson, DDS
Jan Ray Carlson, DDS is listed in the NPPES registry with a primary specialty of Pediatric Dentistry in Lakewood, NY and a listed phone number of (716) 763-0130.
Profile Overview
- NPI
- 1417059478
- Provider Type
- Individual
- Primary Specialty
- Pediatric Dentistry
- Enumeration Date
- September 01, 2006
- Last Updated
- July 28, 2016
Practice Location
- 133 E Fairmount Ave Ste 1
- Lakewood, NY 14750-1950
Phone: (716) 763-0130
Specialties
- Pediatric Dentistry (1223P0221X)
- Pediatric Dentistry (1223P0221X)
Full Record
- NPI
- 1417059478
- Entity Type
- Individual
- Last Name
- Carlson
- First Name
- Jan
- Middle Name
- Ray
- Name Prefix
- Dr.
- Credential
- DDS
- Provider Other Last Name
- Shirley
- Provider Other First Name
- Jan
- Provider Other Middle Name
- Ray
- Provider Other Name Prefix Text
- Dr.
- Provider Other Credential Text
- DDS
- Provider Other Last Name Type Code
- 1
- Mailing Street Address
- 133 E Fairmount Ave Ste 1
- Mailing City
- Lakewood
- Mailing State
- NY
- Mailing ZIP Code
- 14750-1950
- Mailing Country
- US
- Mailing Phone
- (716) 763-0130
- Practice Street Address
- 133 E Fairmount Ave Ste 1
- Practice City
- Lakewood
- Practice State
- NY
- Practice ZIP Code
- 14750-1950
- Practice Country
- US
- Practice Phone
- (716) 763-0130
- Enumeration Date
- September 01, 2006
- Last Updated
- July 28, 2016
- Sex
- Female
- Sole Proprietor
- Yes
- updated_by_file
- npidata_pfile_20050523-20260308.csv
- Taxonomies
- Pediatric Dentistry (1223P0221X), Pediatric Dentistry (1223P0221X)