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General NPI Number Information
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NPI Number | 1245505908
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Entity Type | Organization
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Legal Business Name | CARLISLE FAMILY DENTAL
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Dates
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Enumeration Date | 03/14/2012
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Last Update Date | 03/14/2012
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Provider Practice Location Address
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Address Line | 110 S LOCUST ST
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City | CARLISLE
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State | KY
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Zip | 40311-1123
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Country | US
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Telephone | 859-289-5418
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Fax | 859-289-8153
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Provider Business Mailing Address
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Address Line | 110 S LOCUST ST
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City | CARLISLE
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State | KY
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Zip | 40311-1123
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Country | US
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Telephone | 859-289-5418
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Fax | 859-289-8153
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. BRANDON IRA ALLEN
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Credential | D.M.D.
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Telephone | 859-227-7290
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 8056
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License Number State | KY
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