Provider Demographics
NPI:1548354095
Name:CARROLL, PAUL JOSEPH (DDS)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:JOSEPH
Last Name:CARROLL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5460 DELLWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95118
Mailing Address - Country:US
Mailing Address - Phone:408-265-9600
Mailing Address - Fax:408-265-9211
Practice Address - Street 1:5460 DELLWOOD WAY
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95118
Practice Address - Country:US
Practice Address - Phone:408-265-9600
Practice Address - Fax:408-265-9211
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2010-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA381681223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADSO381680Medicare ID - Type Unspecified