Provider Demographics
NPI:1689043507
Name:CARLISLE DENTAL STUDIO P.C.
Entity Type:Organization
Organization Name:CARLISLE DENTAL STUDIO P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DEJAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLALIC
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:412-726-1043
Mailing Address - Street 1:38 STATE AVE
Mailing Address - Street 2:
Mailing Address - City:CARLISLE
Mailing Address - State:PA
Mailing Address - Zip Code:17013-4431
Mailing Address - Country:US
Mailing Address - Phone:717-243-9300
Mailing Address - Fax:
Practice Address - Street 1:38 STATE AVE
Practice Address - Street 2:
Practice Address - City:CARLISLE
Practice Address - State:PA
Practice Address - Zip Code:17013-4431
Practice Address - Country:US
Practice Address - Phone:717-243-9300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-21
Last Update Date:2015-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0378751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty