Provider Demographics
NPI:1992909808
Name:CARROLL, AARON
Entity type:Individual
Prefix:DR
First Name:AARON
Middle Name:
Last Name:CARROLL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1617 S TUTTLE AVE
Mailing Address - Street 2:SUITE 2B
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-3132
Mailing Address - Country:US
Mailing Address - Phone:941-366-1612
Mailing Address - Fax:941-365-7806
Practice Address - Street 1:1617 S TUTTLE AVE
Practice Address - Street 2:SUITE 2B
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-3132
Practice Address - Country:US
Practice Address - Phone:941-366-1612
Practice Address - Fax:941-365-7806
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 166781223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics