Active NPI
Matthew Richard Carlisle, DMD
- Dentist
- Indian Land, SC
National Provider Identifier
1639586456
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 8492
- Practice address
- 1028 Edgewater Corporate Pkwy
Indian Land, SC 29707 - Phone
- (803) 389-0197
- NPI assigned
- Jul 14, 2014
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | #9830 | NC | |
| Dentist | 122300000X | 8492 | SC | Primary |
Addresses
Primary practice location
1028 Edgewater Corporate Pkwy
Indian Land, SC 29707
Mailing address
1028 Edgewater Corporate Pkwy
Indian Land, SC 29707
Phone (803) 389-0197
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| ZX8492 | Medicaid | SC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8492 | SC | MD | Professional Counselor |
| #9830 | NC | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1405296000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1447891200000",
"number": "1639586456",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1028 EDGEWATER CORPORATE PKWY",
"city": "INDIAN LAND",
"state": "SC",
"postal_code": "29707",
"telephone_number": "803-389-0197"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1028 EDGEWATER CORPORATE PKWY",
"city": "INDIAN LAND",
"state": "SC",
"postal_code": "29707",
"telephone_number": "803-389-0197"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CARLISLE",
"first_name": "MATTHEW",
"middle_name": "RICHARD",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2014-07-14",
"last_updated": "2015-11-19",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "NC",
"license": "#9830",
"primary": false
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "SC",
"license": "8492",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "ZX8492",
"state": "SC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Indian Land, SC
- Calloway Primary Care & Wellness LLC
- Cassandra Nicole Calloway, FNP
- James Matthew Candon III, D.D.S
- Kerri Carder, M.S. CCC-SLP
- Caregivers of Carolina LLC
- Carolina Integrative Health Care LLC
- Carolina Orthopaedic Surgery Associates, PA
- Carolina Podiatry Group, Inc.
- Carolina Roots Dentistry LLC
- Carolina Smile Dentistry, LLC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.