Provider Demographics
NPI:1558957274
Name:PATRICK CARROLL, D.D.S.
Entity Type:Organization
Organization Name:PATRICK CARROLL, D.D.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:WARREN
Authorized Official - Last Name:CARROLL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:870-892-4413
Mailing Address - Street 1:301A COUNTRY CLUB RD
Mailing Address - Street 2:
Mailing Address - City:POCAHONTAS
Mailing Address - State:AR
Mailing Address - Zip Code:72455-8802
Mailing Address - Country:US
Mailing Address - Phone:870-892-4413
Mailing Address - Fax:
Practice Address - Street 1:301A COUNTRY CLUB RD
Practice Address - Street 2:
Practice Address - City:POCAHONTAS
Practice Address - State:AR
Practice Address - Zip Code:72455-8802
Practice Address - Country:US
Practice Address - Phone:870-892-4413
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-16
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental