Provider Demographics
NPI:1801035159
Name:CARRUTH, CAROLINE (DMD)
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:
Last Name:CARRUTH
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:183 E GONZALES RD
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93036-8259
Mailing Address - Country:US
Mailing Address - Phone:805-981-8116
Mailing Address - Fax:
Practice Address - Street 1:183 E GONZALES RD
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93036-8259
Practice Address - Country:US
Practice Address - Phone:805-981-8116
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-10
Last Update Date:2018-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6999-244-9922122300000X
CO9851122300000X
OH30. 0231221223G0001X
CA102351122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1801035159Medicaid