Provider Demographics
NPI:1194076380
Name:CARROLL, KATHLEEN LOUISE (DMD)
Entity type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:LOUISE
Last Name:CARROLL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 985
Mailing Address - Street 2:
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:12866-0985
Mailing Address - Country:US
Mailing Address - Phone:518-879-6606
Mailing Address - Fax:
Practice Address - Street 1:9 CENTURY HILL DR
Practice Address - Street 2:
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110-2113
Practice Address - Country:US
Practice Address - Phone:518-785-3911
Practice Address - Fax:518-785-4910
Is Sole Proprietor?:No
Enumeration Date:2012-09-27
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049457-11223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry