Provider Demographics
NPI:1407961881
Name:CARLIS, IAN MORTON (DMD)
Entity Type:Individual
Prefix:DR
First Name:IAN
Middle Name:MORTON
Last Name:CARLIS
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 1:2597 SCHOENERSVILLE RD
Mailing Address - Street 2:SUITE 301 A
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18017-7325
Mailing Address - Country:US
Mailing Address - Phone:610-866-6663
Mailing Address - Fax:
Practice Address - Street 1:2597 SCHOENERSVILLE RD
Practice Address - Street 2:SUITE 301 A
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18017-7325
Practice Address - Country:US
Practice Address - Phone:610-866-6663
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS 018434 L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice