MEDICARE: DR. TARA L CARROLL DDS

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
1	1223G0001X	General Practice Dentistry	9012	CO

General Provider Information

NPI Number	:	1134118839
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TARA L CARROLL DDS

Provider Business Mailing Address
First Line	:	2855 GEMINI LOOP
Second Line	:
City	:	BROOMFIELD
State	:	CO
Zip	:	80023-4678
Country	:	US
Telephone Number	:	720-323-9509
Fax Number	:

Provider Business Practice Location Address
First Line	:	3200 VILLAGE VISTA DR UNIT 130
Second Line	:
City	:	ERIE
State	:	CO
Zip	:	80516-2521
Country	:	US
Telephone Number	:	303-962-6400
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/17/2005
Last Update Date	:	02/09/2017

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