Healthcare Provider Details

I. General information

NPI: 1861496267
Provider Name (Legal Business Name): PATRICK W CARROLL D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2005
Last Update Date: 05/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 COUNTRY CLUB RD STE A
POCAHONTAS AR
72455-8802
US

IV. Provider business mailing address

301 COUNTRY CLUB RD STE A
POCAHONTAS AR
72455-8802
US

V. Phone/Fax

Practice location:
  • Phone: 870-892-4413
  • Fax: 870-248-1903
Mailing address:
  • Phone: 870-892-4413
  • Fax: 870-248-1903

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2330
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: