Provider Demographics
NPI:1053325704
Name:CARROLL, THOMAS IRBY JR (DMD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:IRBY
Last Name:CARROLL
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:413A MAIN ST S
Mailing Address - Street 2:
Mailing Address - City:AMORY
Mailing Address - State:MS
Mailing Address - Zip Code:38821-4221
Mailing Address - Country:US
Mailing Address - Phone:662-257-6023
Mailing Address - Fax:
Practice Address - Street 1:413A MAIN ST S
Practice Address - Street 2:
Practice Address - City:AMORY
Practice Address - State:MS
Practice Address - Zip Code:38821-4221
Practice Address - Country:US
Practice Address - Phone:662-257-6023
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2465-89122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist