Individual
MATTHEW RICHARD CARLISLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
1028 EDGEWATER CORPORATE PKWY, INDIAN LAND, SC 29707
(803) 389-0197
Mailing address
1028 EDGEWATER CORPORATE PKWY, INDIAN LAND, SC 29707
(803) 389-0197
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
#9830
NC
122300000X
Dentist
Primary
8492
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ZX8492
—
SC
Enumeration date
07/14/2014
Last updated
11/19/2015
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