Provider Demographics
NPI:1245505908
Name:CARLISLE FAMILY DENTAL
Entity type:Organization
Organization Name:CARLISLE FAMILY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:IRA
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:859-227-7290
Mailing Address - Street 1:110 S LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:CARLISLE
Mailing Address - State:KY
Mailing Address - Zip Code:40311-1123
Mailing Address - Country:US
Mailing Address - Phone:859-289-5418
Mailing Address - Fax:859-289-8153
Practice Address - Street 1:110 S LOCUST ST
Practice Address - Street 2:
Practice Address - City:CARLISLE
Practice Address - State:KY
Practice Address - Zip Code:40311-1123
Practice Address - Country:US
Practice Address - Phone:859-289-5418
Practice Address - Fax:859-289-8153
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-14
Last Update Date:2012-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY8056261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100053320Medicaid