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General NPI Number Information
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NPI Number | 1942509179
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Entity Type | Organization
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Legal Business Name | SEDALIA DENTAL - DR. KATHERINE CARROLL, DMD, INC.
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Dates
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Enumeration Date | 03/28/2011
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Last Update Date | 03/28/2011
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Provider Practice Location Address
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Address Line | 5327 HENDRON RD
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City | GROVEPORT
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State | OH
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Zip | 43125-1055
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Country | US
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Telephone | 614-836-2222
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Fax | 614-836-0659
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Provider Business Mailing Address
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Address Line | 5327 HENDRON RD
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City | GROVEPORT
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State | OH
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Zip | 43125-1055
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Country | US
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Telephone | 614-836-2222
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Fax | 614-836-0659
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Authorized Official
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Title or Position | PRESIDENT/DENTIST
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Name | DR. KATHERINE CARROLL
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Credential | DMD
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Telephone | 614-836-2222
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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 | 30022948
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License Number State | OH
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