Provider Demographics
NPI:1700986379
Name:CARLILE, DENNIS J (DDS)
Entity type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:J
Last Name:CARLILE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 W KENOSHA ST
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-8918
Mailing Address - Country:US
Mailing Address - Phone:918-258-8658
Mailing Address - Fax:918-258-5968
Practice Address - Street 1:901 W KENOSHA ST
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-8918
Practice Address - Country:US
Practice Address - Phone:918-258-8658
Practice Address - Fax:918-258-5968
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK42361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice