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NPI Code Detail

MEDICARE: DR. BLAKE CARROLL DDS

MEDICARE: DR. BLAKE 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
11223P0221XPediatric Dentistry0401420090VA

General Provider Information

NPI Number : 1821921750
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BLAKE CARROLL DDS
Provider Business Mailing Address
First Line : 2320 FLOYD AVE APT A
Second Line :
City : RICHMOND
State : VA
Zip : 23220-4408
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1000 E BROAD ST
Second Line :
City : RICHMOND
State : VA
Zip : 23219-1930
Country : US
Telephone Number : 804-828-9095
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/08/2026
Last Update Date : 06/08/2026

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