Provider Demographics
NPI:1871570556
Name:CARROLL, CHRISTOPHER E (DMD)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:E
Last Name:CARROLL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 EAST FOURTH ST
Mailing Address - Street 2:
Mailing Address - City:WINONA
Mailing Address - State:MN
Mailing Address - Zip Code:55987-3512
Mailing Address - Country:US
Mailing Address - Phone:507-452-1543
Mailing Address - Fax:507-452-6874
Practice Address - Street 1:150 EAST FOURTH ST
Practice Address - Street 2:
Practice Address - City:WINONA
Practice Address - State:MN
Practice Address - Zip Code:55987-3512
Practice Address - Country:US
Practice Address - Phone:507-452-1543
Practice Address - Fax:507-452-6874
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN84051223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN4822990OtherMN STATE ID
WI33461700OtherWI MEDICAL ASSISTANCE
MN0010503OtherDORAL DENTAL
MN0010503OtherDORAL DENTAL