Healthcare Provider Details

I. General information

NPI: 1669164505
Provider Name (Legal Business Name): CAROLINA ROSE GRACE DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2023
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

506 1ST AVE SE
CULLMAN AL
35055-4301
US

IV. Provider business mailing address

503 CREST CIR S
JASPER AL
35501-4837
US

V. Phone/Fax

Practice location:
  • Phone: 256-239-3337
  • Fax:
Mailing address:
  • Phone: 205-717-6879
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD.007374-C1
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: