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General NPI Number Information
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NPI Number | 1497083778
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Entity Type | Individual
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Provider Name | ANNALIESE CARLSMITH DDS
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Gender | Female
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Dates
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Enumeration Date | 11/25/2009
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Last Update Date | 05/04/2016
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Provider Practice Location Address
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Address Line | 256 N SAN MATEO DR SUITE 4
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City | SAN MATEO
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State | CA
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Zip | 94401-2624
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Country | US
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Telephone | 650-342-5721
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Fax | 650-342-8626
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Provider Business Mailing Address
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Address Line | 256 N SAN MATEO DR SUITE 4
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City | SAN MATEO
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State | CA
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Zip | 94401-2624
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Country | US
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Telephone | 650-342-5721
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Fax | 650-342-8626
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 58483
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 9585
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License Number State | NC
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