Provider Demographics
NPI:1073532800
Name:CARROLL, ROBERT EARL (GENERAL DENTIST)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:EARL
Last Name:CARROLL
Suffix:
Gender:M
Credentials:GENERAL DENTIST
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 827
Mailing Address - Street 2:2935 BAGNELL DAM BLVD. STE. 102
Mailing Address - City:LAKE OZARK
Mailing Address - State:MO
Mailing Address - Zip Code:65049-0827
Mailing Address - Country:US
Mailing Address - Phone:573-365-6600
Mailing Address - Fax:573-365-6470
Practice Address - Street 1:2935 BAGNELL DAM BLVD STE 102
Practice Address - Street 2:
Practice Address - City:LAKE OZARK
Practice Address - State:MO
Practice Address - Zip Code:65049-8661
Practice Address - Country:US
Practice Address - Phone:573-365-6600
Practice Address - Fax:573-365-6470
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMO139641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice