Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Jacob R Carroll, DMD

Individual provider Student in an Organized Health Care Education/Training Program · NPI 1205192663

Jacob R Carroll, DMD is a Student in an Organized Health Care Education/Training Program in Glendale, Arizona. Practices as a sole proprietor. Licensed in Arizona.

Licensed in
AZ
In the registry since
2012
Specialties on file
2
What do these letters mean?
DMD — Doctor of Dental Medicine
A dentist. Identical training and licensing to a DDS.

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Practice location Address checks out

20100 N 51st Ave Ste C-310
Glendale, AZ 85308-5125
Phone: (623) 572-4300
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Oral and Maxillofacial Surgery (Dentist) (primary) Taxonomy 1223S0112X · Licence D9440 (AZ)
Student in an Organized Health Care Education/Training Program Taxonomy 390200000X

Record details

NPI number1205192663
Entity typeIndividual (Type 1)
GenderMale
Credentials DMD
Sole proprietorYes
NPI enumeratedApril 10, 2012
Last updated in NPPESSeptember 26, 2016
Mailing address20100 N 51st Ave, Suite C-310, Glendale, AZ 85308-5125

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