Healthcare Provider Details

I. General information

NPI: 1538039086
Provider Name (Legal Business Name): CARROLL DENTAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2025
Last Update Date: 11/10/2025
Certification Date: 11/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 ORTEGA ST
TAMAQUA PA
18252-4511
US

IV. Provider business mailing address

12 ORTEGA ST
TAMAQUA PA
18252-4511
US

V. Phone/Fax

Practice location:
  • Phone: 570-668-2339
  • Fax:
Mailing address:
  • Phone: 570-668-2339
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: AMBER CARROLL
Title or Position: OWNER
Credential: DMD
Phone: 570-225-6765