Provider Demographics
NPI:1801116041
Name:CARLSON, JOHN TERRY JR (DMD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:TERRY
Last Name:CARLSON
Suffix:JR
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 1:631 HELEN KELLER BOULEVARD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35404
Mailing Address - Country:US
Mailing Address - Phone:205-553-4477
Mailing Address - Fax:205-553-0202
Practice Address - Street 1:631 HELEN KELLER BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35404-2983
Practice Address - Country:US
Practice Address - Phone:205-553-4477
Practice Address - Fax:205-553-0202
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-10
Last Update Date:2014-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5759122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist