Healthcare Provider Details

I. General information

NPI: 1821875444
Provider Name (Legal Business Name): CARLISLE M VEREEN III DMD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2023
Last Update Date: 09/08/2023
Certification Date: 09/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 TEA OLIVE CT
AIKEN SC
29803
US

IV. Provider business mailing address

15 TEA OLIVE CT
AIKEN SC
29803
US

V. Phone/Fax

Practice location:
  • Phone: 803-642-5747
  • Fax: 803-642-9616
Mailing address:
  • Phone: 803-642-5747
  • Fax: 803-642-9616

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: DR. CARLISLE M VEREEN III
Title or Position: OWNER
Credential: DMD
Phone: 803-642-5747