Provider Demographics
NPI:1255316014
Name:CARLISLE, LYNN DAVID (DDS)
Entity Type:Individual
Prefix:DR
First Name:LYNN
Middle Name:DAVID
Last Name:CARLISLE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2626 N MESA ST
Mailing Address - Street 2:364
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-3130
Mailing Address - Country:US
Mailing Address - Phone:970-310-6328
Mailing Address - Fax:
Practice Address - Street 1:128 CHAFFEE RD.
Practice Address - Street 2:
Practice Address - City:FORT BLISS
Practice Address - State:TX
Practice Address - Zip Code:79906-3811
Practice Address - Country:US
Practice Address - Phone:915-568-5001
Practice Address - Fax:915-568-5174
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO34451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice