Healthcare Provider Details

I. General information

NPI: 1760592547
Provider Name (Legal Business Name): ROGER A CARROLL DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2024 W HENRIETTA RD STE 5J
ROCHESTER NY
14623
US

IV. Provider business mailing address

2024 W HENRIETTA RD STE 5J
ROCHESTER NY
14623
US

V. Phone/Fax

Practice location:
  • Phone: 585-292-1270
  • Fax: 585-292-0219
Mailing address:
  • Phone: 585-292-1270
  • Fax: 585-292-0219

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number034767
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: