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General NPI Number Information
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NPI Number | 1265751770
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Entity Type | Individual
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Provider Name | LESLIE ANN CARROLL D.M.D.
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Gender | Female
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Dates
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Enumeration Date | 05/24/2010
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Last Update Date | 10/21/2014
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Provider Practice Location Address
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Address Line | 1428 W HEBRON PKWY SUITE #140
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City | CARROLLTON
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State | TX
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Zip | 75010-6345
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Country | US
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Telephone | 972-394-1234
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Fax | 972-394-1154
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Provider Business Mailing Address
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Address Line | 1677 OAK RIDGE DR
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City | CORINTH
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State | TX
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Zip | 76210-3044
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Country | US
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Telephone | 585-739-9691
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 28797
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License Number State | TX
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