Provider Demographics
NPI:1346406105
Name:FENN, CARROL ANN (DDS)
Entity Type:Individual
Prefix:DR
First Name:CARROL
Middle Name:ANN
Last Name:FENN
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 1:400 EXECUTIVE CENTER DR
Mailing Address - Street 2:SUITE # 105
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-2917
Mailing Address - Country:US
Mailing Address - Phone:561-686-3335
Mailing Address - Fax:561-687-9183
Practice Address - Street 1:400 EXECUTIVE CENTER DR
Practice Address - Street 2:SUITE # 105
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-2917
Practice Address - Country:US
Practice Address - Phone:561-686-3335
Practice Address - Fax:561-687-9183
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-31
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN88641223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics