MEDICARE: SARA E. CARROLL DDS,DABSCD

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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1720254410
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SARA E. CARROLL DDS,DABSCD

Provider Business Mailing Address
First Line	:	925 OAK ST
Second Line	:
City	:	NORTH AURORA
State	:	IL
Zip	:	60542-1579
Country	:	US
Telephone Number	:	630-906-9520
Fax Number	:	630-906-1915

Provider Business Practice Location Address
First Line	:	925 OAK ST
Second Line	:
City	:	NORTH AURORA
State	:	IL
Zip	:	60542-1579
Country	:	US
Telephone Number	:	630-906-9520
Fax Number	:	630-906-1915

Authorized Official
Title or Position	:	OWNER DENTIST
Name	:	DR. SARA E CARROLL
Credential	:	DDS
Telephone Number	:	630-906-9520

Provider Enumeration Date	:	05/02/2008
Last Update Date	:	05/02/2008

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