Provider Demographics
NPI:1770558546
Name:SCHLISSEL, CARLA H (DDS)
Entity type:Individual
Prefix:DR
First Name:CARLA
Middle Name:H
Last Name:SCHLISSEL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:378 VIOLET ST
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11762-1154
Mailing Address - Country:US
Mailing Address - Phone:516-797-0465
Mailing Address - Fax:
Practice Address - Street 1:500 MONTAUK HWY STE D
Practice Address - Street 2:
Practice Address - City:WEST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11795-4419
Practice Address - Country:US
Practice Address - Phone:631-669-1866
Practice Address - Fax:631-669-1877
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY386271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice