DR. JAN RAY CARLSON (NPI# 1417059478) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1417059478 |
| Entity Type | Individual |
| Full Name | DR. JAN RAY CARLSON |
| Other Name | DR. JAN RAY SHIRLEY |
| Credential | DDS |
| Practice Address |
133 E Fairmount Ave Ste 1 Lakewood NY 14750-1950 |
| Practice Telephone | 7167630130 |
| Mailing Telephone | 7167630130 |
| Enumeration Date | 2006-09-01 |
| Last Update Date | 2016-07-28 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223P0221X |
Dentist Specialization: Pediatric Dentistry |
058246 | NY | Dental Providers |
| N | 1223P0221X |
Dentist Specialization: Pediatric Dentistry |
60345 | KS | Dental Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891901310 | Jan Carlson | Counselor | 504 W 17th St, Austin, TX 78701-1203 | 2007-05-14 |
| 1447325907 | Jan Helene Carlson | Counselor | 1240 Powell St Ste 2c, Emeryville, CA 94608-2600 | 2006-11-21 |
| Street Address |
133 E FAIRMOUNT AVE STE 1 |
| City | LAKEWOOD |
| State | NY |
| Zip Code | 14750-1950 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417499500 | Lakewood Pediatric Dentistry Pllc | Dentist | 133 E Fairmount Ave Ste 1, Lakewood, NY 14750-1950 | 2016-11-07 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699163147 | Craig Richards | Physician Assistant | 390 E Fairmount Ave, Lakewood, NY 14750 | 2015-01-07 |
| 1982849659 | Syed Ali Raza Shamsi | Psychiatry & Neurology | 305 E. Fairmont Avenue, Unit 7, Lakewood, NY 14750 | 2008-12-10 |
| 1942417977 | Stephen C Barresi | Physician Assistant | Chd Meridian Healthcare, Jep, 4720 Bakerst, Ext., Lakewood, NY 14750 | 2007-05-17 |
| 1295947117 | Harold Ronald Carlson | Dentist | 2 East Main Street, Suite 115, Falconer, NY 14750 | 2007-05-04 |
| 1194865907 | David William Todd | Dentist | 120 Southwestern Dr, Lakewood, NY 14750 | 2007-02-08 |
| 1730271248 | Lee Ryan Anderson | Dentist | 909 Hunt Road, Lakewood, NY 14750 | 2006-09-29 |
| 1962416362 | Us Vision Optical Inc | Eyewear Supplier (Equipment, not the service) | Rt 394 Mall Blvd, Lakewood, NY 14750 | 2006-07-28 |
| 1518925437 | Israr A Abbasi | Psychiatry & Neurology | 305 E Fairmount Ave, Lakewood, NY 14750 | 2006-05-02 |
| 1992771190 | Robert Gibbon Jr. | Psychiatry & Neurology | 92 W. Summit St., Lakewood, NY 14750 | 2006-02-27 |
| 1295213684 | Allison Claire Munella | Physician Assistant | 305 E Fairmount Ave, Lakewood, NY 14750 | 2018-07-30 |
| Find all providers in zip 14750 | ||||
| Taxonomy Code | 1223P0221X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Pediatric Dentistry |
| An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225575566 | Babak Yousefi Dental Corporation | Dentist | 4134 Woodruff Ave, Lakewood, CA 90713-3141 | 2017-01-25 |
| 1356762918 | Pediatric Dental Group At Kids First | Dentist | 96 Wadsworth Blvd Unit 150, Lakewood, CO 80226-1512 | 2013-12-30 |
| 1720214638 | Pediatric Dental Group of Lakewood | Dentist | 3333 S Wadsworth Blvd Unit B104, Lakewood, CO 80227-5120 | 2009-06-05 |
| 1528186137 | Daniel H. Cook | Dentist | 6015 100th St Sw, Lakewood, WA 98499-2754 | 2007-03-26 |
| 1104892421 | Brett Wohlstetter | Dentist | 1328 Route 9, Lakewood, NJ 08701-5645 | 2006-02-27 |
| 1639155336 | Lakewood Pediatric Dental Associates | Dentist | 1328 Route 9 South, Suite 11 & 12, Lakewood, NJ 08701-5645 | 2005-12-15 |
| 1417499500 | Lakewood Pediatric Dentistry Pllc | Dentist | 133 E Fairmount Ave Ste 1, Lakewood, NY 14750-1950 | 2016-11-07 |
| 1942681069 | Avi Willis | Dentist | 870 River Ave, Lakewood, NJ 08701-5280 | 2015-06-15 |
| 1841619210 | Aleem Noormohamed | Dentist | 6015 100th St Sw, Lakewood, WA 98499 | 2014-04-14 |
| 1215179148 | Children's Dental Center | Dentist | 2323 S Wadsworth Blvd, Suite # 104, Lakewood, CO 80227-3275 | 2009-03-24 |
| Find all providers in LAKEWOOD | ||||
Please comment or provide details below to improve the information on DR. JAN RAY CARLSON.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.