Provider Demographics
NPI:1689866345
Name:PISKLAK, CARRIE WILLIAM (DDS,MS)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:WILLIAM
Last Name:PISKLAK
Suffix:
Gender:F
Credentials:DDS,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6218 HIGHWAY 6 STE C
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-3845
Mailing Address - Country:US
Mailing Address - Phone:281-403-5599
Mailing Address - Fax:281-403-5590
Practice Address - Street 1:6218 HIGHWAY 6 STE C
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459-3845
Practice Address - Country:US
Practice Address - Phone:281-403-5599
Practice Address - Fax:281-403-5590
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-15
Last Update Date:2007-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX212321223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics