Provider Demographics
NPI:1528286010
Name:PATRICK M CARROLL DMD PSC
Entity type:Organization
Organization Name:PATRICK M CARROLL DMD PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRCIK
Authorized Official - Middle Name:M CARROLL
Authorized Official - Last Name:CARROLL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:502-423-7868
Mailing Address - Street 1:7513 NEW LAGRANGE RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222-4859
Mailing Address - Country:US
Mailing Address - Phone:502-423-7868
Mailing Address - Fax:502-327-7446
Practice Address - Street 1:7513 NEW LAGRANGE RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222-4859
Practice Address - Country:US
Practice Address - Phone:502-423-7868
Practice Address - Fax:502-327-7446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5551122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty