Individual
COREY CARROLL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.M.D
Contact information
Practice address
4323 HILL STREET, FORT JACKSON, SC 29207
(803) 751-6209
Mailing address
4323 HILL STREET, FORT JACKSON, SC 29207
(803) 751-6209
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
9829508-8903
UT
122300000X
Dentist
9829508-9922
UT
Other
Enumeration date
09/01/2016
Last updated
09/01/2016
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