Provider Demographics
NPI:1164627741
Name:CARROLL, ALICIA (DMD)
Entity Type:Individual
Prefix:DR
First Name:ALICIA
Middle Name:
Last Name:CARROLL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9580 SW 107TH AVE
Mailing Address - Street 2:#104
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-2789
Mailing Address - Country:US
Mailing Address - Phone:305-598-1902
Mailing Address - Fax:
Practice Address - Street 1:9580 SW 107TH AVE
Practice Address - Street 2:#104
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-2789
Practice Address - Country:US
Practice Address - Phone:305-598-1902
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN122861223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL650771859OtherTAX ID