Provider Demographics
NPI:1356538656
Name:CARLISLE, MATTHEW DAVID (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:DAVID
Last Name:CARLISLE
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:1225 BRECKENRIDGE DR
Mailing Address - Street 2:SUITE #210
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-1558
Mailing Address - Country:US
Mailing Address - Phone:501-225-4644
Mailing Address - Fax:501-225-4102
Practice Address - Street 1:1225 BRECKENRIDGE DR
Practice Address - Street 2:SUITE #210
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-1558
Practice Address - Country:US
Practice Address - Phone:501-225-4644
Practice Address - Fax:501-225-4102
Is Sole Proprietor?:No
Enumeration Date:2007-10-01
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR3613122300000X
AR341223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
No122300000XDental ProvidersDentist