Provider Demographics
NPI:1407132822
Name:CARUS DENTAL PC
Entity Type:Organization
Organization Name:CARUS DENTAL PC
Other - Org Name:OAK VALLEY DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:BELINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:HUERTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-540-2100
Mailing Address - Street 1:3901 E STAN SCHLUETER LOOP STE 109
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76542-4554
Mailing Address - Country:US
Mailing Address - Phone:254-526-9696
Mailing Address - Fax:254-526-3255
Practice Address - Street 1:3901 E STAN SCHLUETER LOOP STE 109
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76542-4554
Practice Address - Country:US
Practice Address - Phone:254-526-9696
Practice Address - Fax:254-526-3255
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CARUS DENTAL PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-10-31
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1223G0001X
TX136871223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty