Provider Demographics
NPI:1598831380
Name:CARLILE, JOHN G (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:G
Last Name:CARLILE
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 1:38 W GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:SKANEATELES
Mailing Address - State:NY
Mailing Address - Zip Code:13152-1061
Mailing Address - Country:US
Mailing Address - Phone:315-685-2273
Mailing Address - Fax:315-685-0066
Practice Address - Street 1:38 W GENESEE ST
Practice Address - Street 2:
Practice Address - City:SKANEATELES
Practice Address - State:NY
Practice Address - Zip Code:13152-1061
Practice Address - Country:US
Practice Address - Phone:315-685-2273
Practice Address - Fax:315-685-0066
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-26
Last Update Date:2008-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0445091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice