Healthcare Provider Details

I. General information

NPI: 1487239455
Provider Name (Legal Business Name): CAROLYN L JOVANOVIC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2021
Last Update Date: 08/18/2023
Certification Date: 08/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2016 N LOOP 336 W
CONROE TX
77304-3516
US

IV. Provider business mailing address

2016 N LOOP 336 W
CONROE TX
77304-3516
US

V. Phone/Fax

Practice location:
  • Phone: 936-756-6867
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DR. CAROLYN L. JOVANOVIC
Title or Position: DENTIST
Credential: DDS
Phone: 936-756-6867