Provider Demographics
NPI:1619380888
Name:CARROLL, KARISA (DDS)
Entity Type:Individual
Prefix:DR
First Name:KARISA
Middle Name:
Last Name:CARROLL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:918 N FRONT ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19123-1700
Mailing Address - Country:US
Mailing Address - Phone:631-245-3146
Mailing Address - Fax:
Practice Address - Street 1:3601 A ST
Practice Address - Street 2:ST. CHRISTOPHER'S HOSPITAL FOR CHILDREN
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19134-1043
Practice Address - Country:US
Practice Address - Phone:215-427-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-05
Last Update Date:2014-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA00000001223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry