Provider Demographics
NPI:1346782620
Name:J THOMAS CARROLL DDS PC
Entity Type:Organization
Organization Name:J THOMAS CARROLL DDS PC
Other - Org Name:TODAYS DENTISTRY LEAGUE CITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:CARROLL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-385-8875
Mailing Address - Street 1:1901 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-4242
Mailing Address - Country:US
Mailing Address - Phone:281-332-6323
Mailing Address - Fax:
Practice Address - Street 1:1901 E MAIN ST
Practice Address - Street 2:
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573-4242
Practice Address - Country:US
Practice Address - Phone:281-332-6323
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JOHN THOMAS CARROLL DDS PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-11-17
Last Update Date:2016-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX142891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty