Provider Demographics
NPI:1255482592
Name:CARLISLE, SARAH CRISLER (DMD)
Entity Type:Individual
Prefix:DR
First Name:SARAH
Middle Name:CRISLER
Last Name:CARLISLE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:SARAH
Other - Middle Name:ANNE
Other - Last Name:CRISLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:306 FOUNTAINS DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39110-6384
Mailing Address - Country:US
Mailing Address - Phone:601-605-1410
Mailing Address - Fax:601-605-1367
Practice Address - Street 1:306 FOUNTAINS DR
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:MS
Practice Address - Zip Code:39110-6384
Practice Address - Country:US
Practice Address - Phone:601-605-1410
Practice Address - Fax:601-605-1367
Is Sole Proprietor?:No
Enumeration Date:2007-01-15
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3250-031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice