Provider Demographics
NPI:1134118839
Name:CARROLL, TARA L (DDS)
Entity Type:Individual
Prefix:DR
First Name:TARA
Middle Name:L
Last Name:CARROLL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2855 GEMINI LOOP
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80023-4678
Mailing Address - Country:US
Mailing Address - Phone:720-323-9509
Mailing Address - Fax:
Practice Address - Street 1:3200 VILLAGE VISTA DR UNIT 130
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:CO
Practice Address - Zip Code:80516-2521
Practice Address - Country:US
Practice Address - Phone:303-962-6400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-17
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO90121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice