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NPI Code Detail

MEDICARE: DR. LA SHUN LA RUE CARROLL D.D.S.

MEDICARE: DR. LA SHUN LA RUE CARROLL D.D.S.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice DentistryDEN03155RI

General Provider Information

NPI Number : 1104805431
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LA SHUN LA RUE CARROLL D.D.S.
Provider Business Mailing Address
First Line : 1 RIVER ST
Second Line :
City : WAKEFIELD
State : RI
Zip : 02879-3214
Country : US
Telephone Number : 401-269-8925
Fax Number : 888-479-4355
Provider Business Practice Location Address
First Line : 1 RIVER ST
Second Line :
City : WAKEFIELD
State : RI
Zip : 02879-3214
Country : US
Telephone Number : 401-783-5646
Fax Number : 888-479-4355
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/13/2006
Last Update Date : 01/26/2015

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Directions to “ DR. LA SHUN LA RUE CARROLL D.D.S.” Practice Location

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