Provider Demographics
NPI:1710399886
Name:CARUS DENTAL PC
Entity Type:Organization
Organization Name:CARUS DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MALCOLM
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-371-1222
Mailing Address - Street 1:7517 CAMERON RD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78752-2057
Mailing Address - Country:US
Mailing Address - Phone:512-371-1222
Mailing Address - Fax:512-371-3914
Practice Address - Street 1:1130 COTTONWOOD CREEK TRAIL
Practice Address - Street 2:BUILDING A., SUITE 2
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613
Practice Address - Country:US
Practice Address - Phone:512-690-2368
Practice Address - Fax:512-690-2370
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMERICAN DENTAL PARTNERS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-05-23
Last Update Date:2014-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX21059122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty