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General NPI Number Information
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NPI Number | 1912127747
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Entity Type | Organization
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Legal Business Name | J THOMAS CARROLL DDS PC
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Dates
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Enumeration Date | 04/26/2007
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Last Update Date | 01/07/2016
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Provider Practice Location Address
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Address Line | 1801 BROADWAY ST
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City | GALVESTON
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State | TX
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Zip | 77550-4912
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Country | US
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Telephone | 409-762-8443
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Fax | 409-762-0036
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Provider Business Mailing Address
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Address Line | 1801 BROADWAY ST
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City | GALVESTON
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State | TX
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Zip | 77550-4912
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Country | US
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Telephone | 409-762-8443
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Fax | 409-762-0036
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Authorized Official
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Title or Position | OWNER
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Name | DR. JOHN THOMAS CARROLL
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Credential | DDS,P.C
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Telephone | 409-762-8443
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 14289
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License Number State | TX
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