Healthcare Provider Details

I. General information

NPI: 1356312441
Provider Name (Legal Business Name): CAREY H COLLINS DEISLEY D.M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2006
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PSC 836 BOX 2670
FPO AE
09636-9998
US

IV. Provider business mailing address

PSC 836 BOX 2670
FPO AE
09636-9998
US

V. Phone/Fax

Practice location:
  • Phone: 314-624-4811
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDS036682
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDS036682
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: