Provider Demographics
NPI:1245864859
Name:CARROLL, ALEXANDRA KAREN (DMD)
Entity type:Individual
Prefix:DR
First Name:ALEXANDRA
Middle Name:KAREN
Last Name:CARROLL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22415 MARKET ST APT 1221
Mailing Address - Street 2:
Mailing Address - City:CORNELIUS
Mailing Address - State:NC
Mailing Address - Zip Code:28031-3034
Mailing Address - Country:US
Mailing Address - Phone:203-257-2931
Mailing Address - Fax:
Practice Address - Street 1:964 GLENWAY DR STE A
Practice Address - Street 2:
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28625-9204
Practice Address - Country:US
Practice Address - Phone:704-252-5793
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-24
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC95621223G0001X
NC12112122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice