Provider Demographics
NPI:1932310240
Name:FOLLETTE, CAROL EMILY (DDS)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:EMILY
Last Name:FOLLETTE
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 1:2021 SANTA MONICA BLVD STE 704-E
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-2223
Mailing Address - Country:US
Mailing Address - Phone:310-829-4322
Mailing Address - Fax:310-829-9202
Practice Address - Street 1:2021 SANTA MONICA BLVD
Practice Address - Street 2:SUITE 704-E
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2208
Practice Address - Country:US
Practice Address - Phone:310-829-4322
Practice Address - Fax:310-829-9202
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA266361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice