Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 0401005823 | VA |
NPI | 1003011818 |
---|---|
Provider Name | Dr. Robert Steven Carlish |
First Address | Danville, VA 24540-4170 |
Second Address | Danville, VA 24540-4170 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2007 |
Last Update Date | 08/07/2007 |