Provider Demographics
NPI:1790842375
Name:LAWRENCE G CARUTH DMD ASSOC
Entity Type:Organization
Organization Name:LAWRENCE G CARUTH DMD ASSOC
Other - Org Name:CHERRY RIDGE DENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:GLEN
Authorized Official - Last Name:CARUTH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:570-253-4245
Mailing Address - Street 1:3025 LAKE ARIEL HWY
Mailing Address - Street 2:
Mailing Address - City:HONESDALE
Mailing Address - State:PA
Mailing Address - Zip Code:18431
Mailing Address - Country:US
Mailing Address - Phone:570-253-4245
Mailing Address - Fax:570-253-8957
Practice Address - Street 1:3025 LAKE ARIEL HWY
Practice Address - Street 2:
Practice Address - City:HONESDALE
Practice Address - State:PA
Practice Address - Zip Code:18431
Practice Address - Country:US
Practice Address - Phone:570-253-4245
Practice Address - Fax:570-253-8957
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA015861122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty