Healthcare Provider Details

I. General information

NPI: 1821341660
Provider Name (Legal Business Name): CARUS DENTAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2012
Last Update Date: 10/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7517 CAMERON RD SUITE 107
AUSTIN TX
78752-2057
US

IV. Provider business mailing address

16000 PARK VALLEY DR SUITE 160
ROUND ROCK TX
78681-4008
US

V. Phone/Fax

Practice location:
  • Phone: 512-371-1222
  • Fax: 512-371-3914
Mailing address:
  • Phone: 512-651-0444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number21209
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number25659
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number22831
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number15919
License Number StateTX

VIII. Authorized Official

Name: MALCOLM RAY SCOTT
Title or Position: PRESIDENT
Credential: DDS
Phone: 512-371-1222