Healthcare Provider Details

I. General information

NPI: 1689652950
Provider Name (Legal Business Name): DANIEL PATRICK CARROLL D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1125 S LINDEN RD SUITE 800
FLINT MI
48532-4073
US

IV. Provider business mailing address

1125 S LINDEN RD SUITE 800
FLINT MI
48532-4073
US

V. Phone/Fax

Practice location:
  • Phone: 810-733-5310
  • Fax: 810-733-1216
Mailing address:
  • Phone: 810-733-5310
  • Fax: 810-733-1216

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number2901012612
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: