Provider Demographics
NPI:1659023711
Name:CARUS DENTAL PC
Entity Type:Organization
Organization Name:CARUS DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING 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 1:4400-1 E CENTRAL TEXAS EXPY STE B
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76543-7309
Mailing Address - Country:US
Mailing Address - Phone:254-526-9696
Mailing Address - Fax:254-526-3255
Practice Address - Street 1:4400-1 E CENTRAL TEXAS EXPY STE B
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76543-7309
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:2022-01-20
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty