Healthcare Provider Details

I. General information

NPI: 1871763409
Provider Name (Legal Business Name): THOMAS D CARRROLL DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/11/2008
Last Update Date: 07/22/2023
Certification Date: 07/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 N GRAFTON
DUBLIN TX
76446
US

IV. Provider business mailing address

114 N GRAFTON
DUBLIN TX
76446
US

V. Phone/Fax

Practice location:
  • Phone: 254-445-3494
  • Fax: 254-445-2885
Mailing address:
  • Phone: 254-445-3494
  • Fax: 254-445-2885

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number14162
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: