Provider Demographics
NPI:1710116280
Name:CARLISLE, LAURIE ELIZABETH (DMD)
Entity Type:Individual
Prefix:DR
First Name:LAURIE
Middle Name:ELIZABETH
Last Name:CARLISLE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1721 PATTERSON ST
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-2925
Mailing Address - Country:US
Mailing Address - Phone:615-329-4790
Mailing Address - Fax:
Practice Address - Street 1:1721 PATTERSON ST
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-2925
Practice Address - Country:US
Practice Address - Phone:615-329-4790
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-06
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TN9135122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program