Individual
CHRISTOPHER E CARROLL
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
150 EAST FOURTH ST, WINONA, MN 55987-3512
(507) 452-1543
(507) 452-6874
Mailing address
150 EAST FOURTH ST, WINONA, MN 55987-3512
(507) 452-1543
(507) 452-6874
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
8405
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0010503
DORAL DENTAL
MN
01
—
33461700
WI MEDICAL ASSISTANCE
WI
01
—
4822990
MN STATE ID
MN
Enumeration date
12/23/2005
Last updated
07/08/2007
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