MEDICARE: DR. ROGER GREG 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	122300000X	Dentist	12946	TX

General Provider Information

NPI Number	:	1528134764
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROGER GREG CARROLL DDS

Provider Business Mailing Address
First Line	:	4618 RIVERSTONE BLVD
Second Line	:
City	:	MISSOURI CITY
State	:	TX
Zip	:	77459-6141
Country	:	US
Telephone Number	:	281-980-7777
Fax Number	:	281-741-0765

Provider Business Practice Location Address
First Line	:	4618 RIVERSTONE BLVD
Second Line	:
City	:	MISSOURI CITY
State	:	TX
Zip	:	77459-6141
Country	:	US
Telephone Number	:	281-980-7777
Fax Number	:	281-741-0765

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

Provider Enumeration Date	:	11/28/2006
Last Update Date	:	08/28/2013

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