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General NPI Number Information
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NPI Number | 1528374253
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Entity Type | Individual
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Provider Name | LAURA R CARROLL D.M.D
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Gender | Female
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Dates
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Enumeration Date | 08/18/2010
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Last Update Date | 10/23/2019
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Provider Practice Location Address
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Address Line | 6344 W. HWY 146 STE 100
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City | CRESTWOOD
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State | KY
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Zip | 40014
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Country | US
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Telephone | 502-241-4121
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Fax | 502-241-5787
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Provider Business Mailing Address
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Address Line | 6344 W. HWY 146 STE 100
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City | CRESTWOOD
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State | KY
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Zip | 40014
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Country | US
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Telephone | 502-241-4121
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Fax | 502-241-5787
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 019.028474
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 8864
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License Number State | KY
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