Provider Demographics
NPI:1669164505
Name:GRACE, CAROLINA ROSE (DMD)
Entity type:Individual
Prefix:
First Name:CAROLINA
Middle Name:ROSE
Last Name:GRACE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1214 TOMMY ROBINSON RD
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:AL
Mailing Address - Zip Code:35504-6627
Mailing Address - Country:US
Mailing Address - Phone:205-717-6879
Mailing Address - Fax:
Practice Address - Street 1:28779 NICK DAVIS RD
Practice Address - Street 2:
Practice Address - City:HARVEST
Practice Address - State:AL
Practice Address - Zip Code:35749-7009
Practice Address - Country:US
Practice Address - Phone:256-233-4600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-22
Last Update Date:2025-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALD.007374-C1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist