Healthcare Provider Details

I. General information

NPI: 1649709130
Provider Name (Legal Business Name): ACCESS CARROLL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 DISTILLERY RD STE 200
WESTMINSTER MD
21157-5344
US

IV. Provider business mailing address

10 DISTILLERY DRIVE SUITE 200
WESTMINSTER MD
21157
US

V. Phone/Fax

Practice location:
  • Phone: 410-871-1478
  • Fax:
Mailing address:
  • Phone: 410-871-1478
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TAMMY LEE BLACK
Title or Position: EXECUTIVE DIRECTOR AND CEO
Credential: RN
Phone: 410-871-3218