Healthcare Provider Details

I. General information

NPI: 1871570556
Provider Name (Legal Business Name): CHRISTOPHER E CARROLL DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/23/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 EAST FOURTH ST
WINONA MN
55987-3512
US

IV. Provider business mailing address

150 EAST FOURTH ST
WINONA MN
55987-3512
US

V. Phone/Fax

Practice location:
  • Phone: 507-452-1543
  • Fax: 507-452-6874
Mailing address:
  • Phone: 507-452-1543
  • Fax: 507-452-6874

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number8405
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: