Basic Information
| Provider Information | |||||||||
| NPI: | 1003011818 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CARLISH | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | STEVEN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 140 PINEY FOREST ROAD | ||||||||
| Address2: | SUITE # 3 | ||||||||
| City: | DANVILLE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 245404170 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4347931400 | ||||||||
| FaxNumber: | 4347931401 | ||||||||
| Practice Location | |||||||||
| Address1: | 140 PINEY FOREST ROAD | ||||||||
| Address2: | SUITE # 3 | ||||||||
| City: | DANVILLE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 245404170 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4347931400 | ||||||||
| FaxNumber: | 4347931401 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/20/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223P0300X | 0401005823 | VA | Y | Dental Providers | Dentist | Periodontics |
No ID Information.