NPIMap

Kelly D Carroll, DDS

Individual provider Active NPI General Practice Dentistry · Salt Lake City, UT

NPI 1003962960 · NPPES record last updated Aug 2, 2018

Key facts

NPI
1003962960
Entity type
Individual (NPI type 1)
Primary specialty
General Practice Dentistry 1223G0001X
License
3251999922 (UT)
Practice address
2114 Fort Union Blvd
Salt Lake City, UT 84121
Phone
(801) 943-2020
NPI assigned
Jan 25, 2007
Sex
Male
Sole proprietor
Yes

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
3251999922UTMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Kelly D. Carroll D.D.S., PC Current Accepting new patients

Locations

2114 E Fort Union Blvd
Salt Lake City, UT 84121
Phone (801) 943-2020

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 3251999922 UT Yes

Addresses

Primary practice location

2114 Fort Union Blvd
Salt Lake City, UT 84121

Mailing address

4023 E Prospector Dr
SLC, UT 84121
Phone (801) 733-5858

Other providers in Salt Lake City, UT

All providers in Salt Lake City, UT · General Practice Dentistry in Utah

Sources for this page

Verify at the official NPI Registry.