MEDICARE: DR. MATTHEW DAVID CARLISLE D.D.S., M.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	3613	AR
2	1223P0300X	Periodontics	34	AR

General Provider Information

NPI Number	:	1356538656
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MATTHEW DAVID CARLISLE D.D.S., M.S.

Provider Business Mailing Address
First Line	:	1225 BRECKENRIDGE DR
Second Line	:	SUITE #210
City	:	LITTLE ROCK
State	:	AR
Zip	:	72205-1558
Country	:	US
Telephone Number	:	501-225-4644
Fax Number	:	501-225-4102

Provider Business Practice Location Address
First Line	:	1225 BRECKENRIDGE DR
Second Line	:	SUITE #210
City	:	LITTLE ROCK
State	:	AR
Zip	:	72205-1558
Country	:	US
Telephone Number	:	501-225-4644
Fax Number	:	501-225-4102

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/01/2007
Last Update Date	:	02/25/2016

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