Provider Demographics
NPI:1467706713
Name:JANETTE CARROLL DDS PLLC
Entity Type:Organization
Organization Name:JANETTE CARROLL DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JANETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:CARROLL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:360-424-0123
Mailing Address - Street 1:2210 KULSHAN VIEW DR.
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MT. VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98273
Mailing Address - Country:US
Mailing Address - Phone:360-424-0123
Mailing Address - Fax:360-424-9023
Practice Address - Street 1:2210 KULSHAN VIEW DR.
Practice Address - Street 2:SUITE 101
Practice Address - City:MT. VERNON
Practice Address - State:WA
Practice Address - Zip Code:98273
Practice Address - Country:US
Practice Address - Phone:360-424-0123
Practice Address - Fax:360-424-9023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-07
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00006198122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty