Provider Demographics
NPI:1720254410
Name:SARA E. CARROLL DDS,DABSCD
Entity Type:Organization
Organization Name:SARA E. CARROLL DDS,DABSCD
Other - Org Name:CARROLL MOBILE DENTISTRY
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SARA
Authorized Official - Middle Name:E
Authorized Official - Last Name:CARROLL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:630-906-9520
Mailing Address - Street 1:925 OAK ST
Mailing Address - Street 2:
Mailing Address - City:NORTH AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60542-1579
Mailing Address - Country:US
Mailing Address - Phone:630-906-9520
Mailing Address - Fax:630-906-1915
Practice Address - Street 1:925 OAK ST
Practice Address - Street 2:
Practice Address - City:NORTH AURORA
Practice Address - State:IL
Practice Address - Zip Code:60542-1579
Practice Address - Country:US
Practice Address - Phone:630-906-9520
Practice Address - Fax:630-906-1915
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-02
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental