Provider Demographics
NPI:1326429093
Name:CARROLL, DESTINIE (DDS)
Entity Type:Individual
Prefix:DR
First Name:DESTINIE
Middle Name:
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 1:3121 N GEORGE BUSH FWY
Mailing Address - Street 2:#113
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75040-2752
Mailing Address - Country:US
Mailing Address - Phone:469-368-9889
Mailing Address - Fax:
Practice Address - Street 1:3121 N GEORGE BUSH FWY
Practice Address - Street 2:#113
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75040-2752
Practice Address - Country:US
Practice Address - Phone:469-368-9889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-17
Last Update Date:2015-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX309861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice