Susan A. Carroll, D.D.S.
Individual provider Active NPI General Practice Dentistry · Homer Glen, IL
NPI 1265442255 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1265442255
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- Practice address
- 15915 S Crystal Creek Dr Ste B
Homer Glen, IL 60491-9381 - Phone
- (708) 301-8660
- Fax
- (708) 301-8661
- NPI assigned
- Aug 9, 2006
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 019021709 | IL | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dr. Edward J. Brennan, Jr. D.D.S. & Dr. Mark J. Peloquin, D.D.S. PC | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | IL | Yes |
Addresses
Primary practice location
15915 S Crystal Creek Dr Ste B
Homer Glen, IL 60491-9381
Mailing address
15915 S Crystal Creek Dr Ste B
Homer Glen, IL 60491-9381
Phone (708) 301-8660
Other providers in Homer Glen, IL
- Hollie Fay Campbell
- Ahmet Can
- Ashley Canny
- Lauren Caratachea
- Heather Carrero
- Zaira Carvajal
- Melanie A Cerinich
- Ashley Cerullo
- Sudarsana Chakrabarti
- Virginia Diane Chilcutt
All providers in Homer Glen, IL · General Practice Dentistry in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.