Provider Demographics
NPI:1497083778
Name:CARLSMITH, ANNALIESE (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANNALIESE
Middle Name:
Last Name:CARLSMITH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:256 N SAN MATEO DR
Mailing Address - Street 2:SUITE 4
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94401-2624
Mailing Address - Country:US
Mailing Address - Phone:650-342-5721
Mailing Address - Fax:650-342-8626
Practice Address - Street 1:256 N SAN MATEO DR
Practice Address - Street 2:SUITE 4
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401-2624
Practice Address - Country:US
Practice Address - Phone:650-342-5721
Practice Address - Fax:650-342-8626
Is Sole Proprietor?:No
Enumeration Date:2009-11-25
Last Update Date:2016-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA584831223G0001X
NC95851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice