Provider Demographics
NPI:1790896520
Name:ALBRITTON, CARROLL MARK (DDS)
Entity Type:Individual
Prefix:
First Name:CARROLL
Middle Name:MARK
Last Name:ALBRITTON
Suffix:
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 1:120 AUSTIN HWY STE 101
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-5339
Mailing Address - Country:US
Mailing Address - Phone:210-805-8446
Mailing Address - Fax:210-805-0415
Practice Address - Street 1:120 AUSTIN HWY STE 101
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-5339
Practice Address - Country:US
Practice Address - Phone:210-805-8446
Practice Address - Fax:210-805-0415
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15381122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist