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General NPI Number Information
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NPI Number | 1861496267
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Entity Type | Individual
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Provider Name | PATRICK W CARROLL D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 06/13/2005
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Last Update Date | 05/31/2012
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Provider Practice Location Address
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Address Line | 301 COUNTRY CLUB RD STE A
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City | POCAHONTAS
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State | AR
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Zip | 72455-8802
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Country | US
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Telephone | 870-892-4413
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Fax | 870-248-1903
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Provider Business Mailing Address
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Address Line | 301 COUNTRY CLUB RD STE A
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City | POCAHONTAS
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State | AR
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Zip | 72455-8802
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Country | US
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Telephone | 870-892-4413
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Fax | 870-248-1903
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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 | 2330
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License Number State | AR
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