Provider Demographics
NPI:1235366642
Name:CARROLL, SAM A (DMD)
Entity Type:Individual
Prefix:DR
First Name:SAM
Middle Name:A
Last Name:CARROLL
Suffix:
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 1:550 E 32ND ST STE 6
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85365-3431
Mailing Address - Country:US
Mailing Address - Phone:928-344-1060
Mailing Address - Fax:928-726-3401
Practice Address - Street 1:550 E 32ND ST STE 6
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85365-3431
Practice Address - Country:US
Practice Address - Phone:928-344-1060
Practice Address - Fax:928-726-3401
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-12
Last Update Date:2012-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD79711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice