| NPI | 1568062685 |
|---|---|
| Doing Business As | BLUE SKYE DENTAL |
| Former Legal Business Name | KERRY CARLSON DDS,PLLC |
| Entity Type | Organization |
| Authorized Contact | JENNIFER D IHLE Business Administrator 479-754-2042 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2020-10-28 |
| Last Update Date | 2020-10-28 |