Provider Demographics
NPI:1326157413
Name:CARLISLE, DAVID J (DDS)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:J
Last Name:CARLISLE
Suffix:
Gender:
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31737 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:LAKE ELSINORE
Mailing Address - State:CA
Mailing Address - Zip Code:92530-7890
Mailing Address - Country:US
Mailing Address - Phone:951-522-4253
Mailing Address - Fax:
Practice Address - Street 1:4075 COPPER RIDGE DR
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-7059
Practice Address - Country:US
Practice Address - Phone:231-844-4601
Practice Address - Fax:231-844-4603
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA437651223G0001X
MI29016020141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice