Provider Demographics
NPI:1205978251
Name:CARROLL, JANETTE E (DDS)
Entity type:Individual
Prefix:
First Name:JANETTE
Middle Name:E
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 1:2210 KULSHAN VIEW DR
Mailing Address - Street 2:SUITE #101
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98273-2779
Mailing Address - Country:US
Mailing Address - Phone:360-424-0123
Mailing Address - Fax:360-424-9023
Practice Address - Street 1:2210 KULSHAN VIEW DR
Practice Address - Street 2:SUITE #101
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98273-2779
Practice Address - Country:US
Practice Address - Phone:360-424-0123
Practice Address - Fax:360-424-9023
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000061981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice