MEDICARE: CAROUSEL DENTAL PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1073110888
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAROUSEL DENTAL PLLC

Provider Business Mailing Address
First Line	:	7146 GRAND OAKS RD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75230-4223
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2315 GUS THOMASSON RD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75228-3004
Country	:	US
Telephone Number	:	916-897-6682
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JOHN MEEKAY
Credential	:	DMD
Telephone Number	:	916-897-6682

Provider Enumeration Date	:	10/05/2020
Last Update Date	:	10/05/2020

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