Provider Demographics
NPI:1528374253
Name:CARROLL, LAURA R (DMD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:R
Last Name:CARROLL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6344 W. HWY 146 STE 100
Mailing Address - Street 2:
Mailing Address - City:CRESTWOOD
Mailing Address - State:KY
Mailing Address - Zip Code:40014
Mailing Address - Country:US
Mailing Address - Phone:502-241-4121
Mailing Address - Fax:502-241-5787
Practice Address - Street 1:6344 W. HWY 146 STE 100
Practice Address - Street 2:
Practice Address - City:CRESTWOOD
Practice Address - State:KY
Practice Address - Zip Code:40014
Practice Address - Country:US
Practice Address - Phone:502-241-4121
Practice Address - Fax:502-241-5787
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-18
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.028474122300000X
KY8864122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist