Provider Demographics
NPI:1174741011
Name:CARLTON, JANICE SISTRUNK (DDS)
Entity type:Individual
Prefix:DR
First Name:JANICE
Middle Name:SISTRUNK
Last Name:CARLTON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:JANICE
Other - Middle Name:VICTORIA
Other - Last Name:SISTRUNK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:2608 PIONEER RD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32808-3221
Mailing Address - Country:US
Mailing Address - Phone:407-299-3232
Mailing Address - Fax:407-299-5828
Practice Address - Street 1:2608 PIONEER RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32808-3221
Practice Address - Country:US
Practice Address - Phone:407-299-3232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2012-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN9771122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL075122700Medicaid