Provider Demographics
NPI:1689652950
Name:CARROLL, DANIEL PATRICK (DMD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:PATRICK
Last Name:CARROLL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1125 S LINDEN RD
Mailing Address - Street 2:SUITE 800
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-4073
Mailing Address - Country:US
Mailing Address - Phone:810-733-5310
Mailing Address - Fax:810-733-1216
Practice Address - Street 1:1125 S LINDEN RD
Practice Address - Street 2:SUITE 800
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-4073
Practice Address - Country:US
Practice Address - Phone:810-733-5310
Practice Address - Fax:810-733-1216
Is Sole Proprietor?:No
Enumeration Date:2006-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010126121223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4060491Medicaid