Healthcare Provider Details

I. General information

NPI: 1992870570
Provider Name (Legal Business Name): RICHARD L SEARS THOMAS N CARUSO DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 SCHUYLER ST
BOONVILLE NY
13309
US

IV. Provider business mailing address

3 SCHUYLER ST
BOONVILLE NY
13309
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number04028
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number039384
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number046947-1
License Number StateNY

VIII. Authorized Official

Name: DR. THOMAS N CARUSO
Title or Position: DENTIST VICE PRES
Credential: DDS
Phone: 315-942-4514