Provider Demographics
NPI:1326422668
Name:CARUS DENTAL PC
Entity Type:Organization
Organization Name:CARUS DENTAL PC
Other - Org Name:CARUS DENTAL CEDAR PARK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIAL COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:CELIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HAYES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-540-2100
Mailing Address - Street 1:1130 COTTONWOOD CREEK TRL STE A2
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-7862
Mailing Address - Country:US
Mailing Address - Phone:512-690-2368
Mailing Address - Fax:
Practice Address - Street 1:1130 COTTONWOOD CREEK TRL STE A2
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-7862
Practice Address - Country:US
Practice Address - Phone:512-690-2368
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CARUS DENTAL PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-07-16
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX210591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty