Provider Demographics
NPI:1811091846
Name:CARROLL, ROBERT M (DMD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:M
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 1:406 KINGS HWY S
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08034-2511
Mailing Address - Country:US
Mailing Address - Phone:856-429-6462
Mailing Address - Fax:856-429-7807
Practice Address - Street 1:406 KINGS HWY S
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08034-2511
Practice Address - Country:US
Practice Address - Phone:856-429-6462
Practice Address - Fax:856-429-7807
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJD124411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice