Provider Demographics
NPI:1689848293
Name:CARUSO, THERESA M (DDS)
Entity Type:Individual
Prefix:DR
First Name:THERESA
Middle Name:M
Last Name:CARUSO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4205 N POINT PKWY
Mailing Address - Street 2:BLDG C
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022-8808
Mailing Address - Country:US
Mailing Address - Phone:770-664-4936
Mailing Address - Fax:
Practice Address - Street 1:4205 N POINT PKWY
Practice Address - Street 2:BLDG C
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30022-8808
Practice Address - Country:US
Practice Address - Phone:770-664-4936
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-15
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA11964122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist