Provider Demographics
NPI:1215183058
Name:CARROLL, KATHERINE ANNE (DMD)
Entity type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:ANNE
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 1:137 S COLUMBIA AVE
Mailing Address - Street 2:
Mailing Address - City:BEXLEY
Mailing Address - State:OH
Mailing Address - Zip Code:43209-1622
Mailing Address - Country:US
Mailing Address - Phone:614-836-2222
Mailing Address - Fax:
Practice Address - Street 1:337 MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:GROVEPORT
Practice Address - State:OH
Practice Address - Zip Code:43125-1127
Practice Address - Country:US
Practice Address - Phone:614-836-2222
Practice Address - Fax:614-343-2212
Is Sole Proprietor?:No
Enumeration Date:2008-08-12
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.022948122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH30.022948OtherOHIO DENTAL BOARD