Healthcare Provider Details

I. General information

NPI: 1366522013
Provider Name (Legal Business Name): CARUS DENTAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 01/19/2022
Certification Date: 01/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 W HOPKINS
SAN MARCUS TX
78666
US

IV. Provider business mailing address

301 W HOPKINS ST
SAN MARCOS TX
78666-4403
US

V. Phone/Fax

Practice location:
  • Phone: 512-396-7268
  • Fax: 512-353-8964
Mailing address:
  • Phone: 512-396-7268
  • Fax: 512-353-8964

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: CELIA HAYES
Title or Position: CREDENTIALING COORDINATORS
Credential:
Phone: 217-540-2100