Provider Demographics
NPI:1578527016
Name:CARROLL, JAMES RICHARD JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:RICHARD
Last Name:CARROLL
Suffix:JR
Gender:M
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:PO BOX 1123
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75091-1123
Mailing Address - Country:US
Mailing Address - Phone:903-892-1052
Mailing Address - Fax:903-892-0607
Practice Address - Street 1:420 N RUSK ST
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75090-5858
Practice Address - Country:US
Practice Address - Phone:903-892-1052
Practice Address - Fax:903-892-0607
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-13
Last Update Date:2016-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX102971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice