Provider Demographics
NPI:1972683621
Name:CARUS DENTAL PC
Entity Type:Organization
Organization Name:CARUS DENTAL PC
Other - Org Name:CARUS DENTAL KINGWOOD
Other - Org Type:Doing Business As
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 1:4003 RUSTIC WOODS DR STE E
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339-2600
Mailing Address - Country:US
Mailing Address - Phone:281-360-3630
Mailing Address - Fax:281-360-4259
Practice Address - Street 1:4003 RUSTIC WOODS DR
Practice Address - Street 2:STE E
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339
Practice Address - Country:US
Practice Address - Phone:281-360-3630
Practice Address - Fax:281-360-4259
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CARUS DENTAL PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-17
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty