Provider Demographics
NPI:1841603594
Name:KROLL, CHARLOTTE LORAINE (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHARLOTTE
Middle Name:LORAINE
Last Name:KROLL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:CHARLOTTE
Other - Middle Name:
Other - Last Name:PAINTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:350 N CLARK ST
Mailing Address - Street 2:SUITE 600
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60654-4712
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:24541 GRATIOT AVE.
Practice Address - Street 2:
Practice Address - City:EASTPOINTE
Practice Address - State:MI
Practice Address - Zip Code:48021
Practice Address - Country:US
Practice Address - Phone:312-274-0308
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-10
Last Update Date:2014-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010212591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice