Provider Demographics
NPI:1003011818
Name:CARLISH, ROBERT STEVEN (DMD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:STEVEN
Last Name:CARLISH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 PINEY FOREST ROAD
Mailing Address - Street 2:SUITE # 3
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24540-4170
Mailing Address - Country:US
Mailing Address - Phone:434-793-1400
Mailing Address - Fax:434-793-1401
Practice Address - Street 1:140 PINEY FOREST ROAD
Practice Address - Street 2:SUITE # 3
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24540-4170
Practice Address - Country:US
Practice Address - Phone:434-793-1400
Practice Address - Fax:434-793-1401
Is Sole Proprietor?:No
Enumeration Date:2007-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010058231223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics