Provider Demographics
NPI:1801054069
Name:CARROLL, DAVID (DMD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:CARROLL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15801 BISCAYNE BLVD
Mailing Address - Street 2:200
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33160-4601
Mailing Address - Country:US
Mailing Address - Phone:305-948-9102
Mailing Address - Fax:
Practice Address - Street 1:15801 BISCAYNE BLVD
Practice Address - Street 2:200
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33160-4601
Practice Address - Country:US
Practice Address - Phone:305-948-9102
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-23
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN00128301223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics