Provider Demographics
NPI:1235343716
Name:CARUSO, PHILIP MATTHEW (DDS)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:MATTHEW
Last Name:CARUSO
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 1:20 RUTH ELLEN ROAD
Mailing Address - Street 2:
Mailing Address - City:HOLLISTON
Mailing Address - State:MA
Mailing Address - Zip Code:01746-1216
Mailing Address - Country:US
Mailing Address - Phone:508-429-5777
Mailing Address - Fax:508-429-6548
Practice Address - Street 1:20 RUTH ELLEN ROAD
Practice Address - Street 2:
Practice Address - City:HOLLISTON
Practice Address - State:MA
Practice Address - Zip Code:01746-1216
Practice Address - Country:US
Practice Address - Phone:508-429-5777
Practice Address - Fax:508-429-6548
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMA107051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0298557Medicaid