Healthcare Provider Details

I. General information

NPI: 1841324258
Provider Name (Legal Business Name): THOMAS NICHOLAS CARUSO DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 02/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 SCHUYLER ST
BOONVILLE NY
13309-1109
US

IV. Provider business mailing address

3 SCHUYLER ST
BOONVILLE NY
13309-1109
US

V. Phone/Fax

Practice location:
  • Phone: 315-942-4514
  • Fax: 315-942-3572
Mailing address:
  • Phone: 315-942-4514
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number040238
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: